QuestionsandAnswersfromtheWebinarCommunityHealthWorkersTheirRoleinPreventingandControllingChronicConditions

Thepurposeofthiswebinarwas to answer thefollowing questions(1)Whoare communityhealthworkers(CHWs)and(2) Whataretheirroles in preventing andcontrollingchronicconditionsItalsodescribedCentersforDiseaseControlandPreventionrsquos(CDC)strategiestoengageCHWsinthepreventionandcontrolofchronicconditionsThespeakers discussedthe historyandevolutionofCHWsat the nationallevelalongwith highlightingthe experienceof some organizationsimplementingtheCHWmodelandprovidinglessonslearnedonhowtoworkeffectively withCHWstoaddresschronicconditions whileachievinghealthequityWebinarparticipants raisedthefollowingquestions

QuestionsrelatedtoEvaluationandMonitoring 1 What types of evaluations exist for monitoring the work done by CHWsCurrentlythereareno specific evaluationstandardsforwork conductedbyCHWsHowever wecanlearnfromalreadyexisting evaluation resourcesto guideCHW‐specific evaluation effortsCDC offers specificguidanceonconductingprogrammaticevaluationsatthe AFrameworkforProgramEvaluation websiteandinthe MMWR reportldquoFrameworkforProgramEvaluationin PublicHealthrdquo

Whenbeginning any evaluationitisimportanttoconsiderthe needfor theevaluationandevaluation questions CHW‐specificevaluationsshouldbeplaced inthecontextoftheoverallprogramororganizationTherearemanyaspectsofCHW workand programsthatcanbeevaluated includingtraining CHWintegrationandperceptionsofthevalueaddedbyCHWspatienthealthoutcomes(egclinicalmeasurements)programmatic data(eg numberofpeopleenrolledinaprogram) and economicimplications The Community Health Worker Evaluation Tool Kit is a resourcethatspecificallyaddressesevaluating CHWeffortsis acompilation ofCHWevaluationmaterials

OverallRolesofCHWs 1 Much of the work conducted by CHWs could be categorized as patient navigation specifically the work

that touches the health care system Can you talk about how you make the distinction between the CHWs and patient navigators

AccordingtotheCHWSectionof theAmerican PublicHealthAssociationCHWs arefrontlinepublichealthworkers whoaretrustedmembersoforhaveanunusuallyclose understandingofthecommunityservedThistrusting relationshipenablesCHWstoserve asaliaison

1

betweenhealthservicesorsocialservicesand thecommunity to facilitate access toservicesandimprovethequalityandculturalcompetenceofservicedeliveryCHWsalsobuildindividualandcommunitycapacity byincreasinghealthknowledge andself‐sufficiency througharangeof activitiessuchasoutreachcommunityeducationinformalcounselingsocialsupportand advocacy

Traditionallynon‐clinicallytrainedCHWshavebeenusedprimarily inanoutreachcapacityprovidingtopic‐specifichealtheducationcommunityadvocacyandempowermentresourcesocialserviceconnectionandreferralandcoordinationofcommunityeventssuchashealthfairsandscreeningsPerhapsmostimportantlyCHWrsquosuniqueunderstandingof thechallengesfacingtheir community allowsthemtofunctionasldquobarrierbustersrdquo tohelpcommunitymembersappropriately accessandusehealth careservices

Patientnavigatorsare workerstrained tohelppatientsldquonavigaterdquotheirway throughthecomplexandfragmentedhealthcaresystemTheyoffer arangeofservices(eg providesocialserviceandresourceinformation assist withhealth and insuranceformsfindtransportationalternativesmake connection tospecialty healthcare)Whilenavigatorsactasthoughtfulandinformedguides throughtheoftenconfusingandoverwhelmingmazeofhealthcare servicestheirroles typicallydonotencompasshealthpromotioneducationdiseaseself‐managementcoaching individual andcommunity advocacyorhealthequity

Althoughthereisnorequirement thatapatientnavigator bea communityhealth representative(CHR)itcouldbearguedthatthebestnavigatorwillalsobeaCHWThepersonalcharacteristics ofaCHWmaymorereadily facilitate a trustingrelationshipandanopendialogueaboutthebarriers andchallengespreventingpatients fromreceivingthe healthcare theyneed Knowing andunderstanding thosebarriers willenabletheCHWtohelpthepatientnavigate thesystemandreceivethoseservicesInadditionaCHW bringstotheroleof navigator theunderstandingof theimportanceofpatientadvocacyandempowerment inimprovinganindividualrsquosabilitytomanagetheirhealth

Ontheotherhandmanypatient navigatorprogramsemploynursesor socialworkersinthe navigator roleThisis alegitimate designchoiceanddoes not inanywaydiminishthevalueorcontributionofthe patientnavigator

2 What roles do CHWs play in clinical settings throughout the United States

AlthoughCHWsrsquorolesvarydependingonlocalandculturalsettings theymostoften arefoundworkinginunderprivileged marginalizedcommunitieswhere peoplemayhavelimitedresourceslackaccessto qualityhealthcarelackthe meanstopayforhealthcarenotspeakEnglishfluentlyorhave culturalbeliefs values andbehaviorsdifferentfromthoseofthedominantwestern‐typeofhealth caresystemInthese communitiesCHWsplayanintegralroleinhelpingsystemsbecomemoreculturallyappropriateandrelevanttothepeoplethesystemstheyserve

2

CHWstypicallyhavedeeprootsor sharedlife experiences inthecommunities theyserve Theyshare similarvaluesethnicbackground andsocioeconomic statusandusuallythesamelanguageas thepeopletheyserve ThusCHWactsasabridgebetweenthe communityandthehealthcaregovernment andsocialservicesystems

ResponsibilitiesofCHWsinclinicalsettings mightincludeto

Helpindividualsfamiliesgroupsandcommunit iesdeveloptheircapacityandaccesstoresourcesincludinghealth insurancefoodhousingqualityc areand healthinformation

Facilitatecommunicationandclientempowermentininteractions withhealthcareorsocialservicesystems

Helphealthcareandsocialservicesystemsbecomeculturallyr elevantandresponsivet otheirservicepopulation

Helppeopleunderstand theirhealthconditionsanddevelopstrategiestoimprove theirhealthandwell‐being

Helpbuild understandingandsocialcapitaltosupporthealthierbehaviorsand lifestylechoices

Deliverhealthinformationusing culturallyappropriatetermsandconcepts Linkpeopletohealthcareorsocialservice r esources Provideinformalcounselingsupportandfollow‐up Advocatefor localhealthneeds Providehealthservices(egbloodpressuremonitor ingfir staidaccess) Makehomevisitstochronicallyillpatientspr egnantwomennursingmothersindividualsathighrisk o fhealthproblemsandtheelderly

Translatea ndinterpretforclientsandhealth c areorsocialservice providersTheyshouldonlybeexpectedtodosoiftheyareseparatelyandpro fessionallytrainedfor theseduties

Rolesof CHWsinDiabetesSelf‐ManagementEducation 1 Can Diabetes Self‐Management Education (DSME) be facilitated by CHWsHistoricallynursesand dietitians were themainprovidersof diabeteseducationReflecting theevolving healthcare environmenta numberofstudieshave endorsedamultidisciplinaryteamapproachtodiabetescareeducationandsupportRecentlylayhealthandcommunityhealthworkersandpeercounselorsoreducators(amongothers) havebeenshowntocontribute effectivelyaspartoftheDSMEteamandinprovidingDSMETheAmericanAssociationofDiabetesEducators(AADE)endorsedsignificant rolesforCHWsinDSME1

2 Will CHWs need to work under the direction of a provider in order to teach DSME

1 American Association of Diabetes Educators A Sustainable Model of Diabetes Self‐Management EducationTraining Involves a Multi‐Level Team That Can Include Community Health Workers Chicago IL AADE

3

Accordingtothe CommunityHealth Workersin Diabetes Management andPrevention AADEPractice SynopsisCHWsrsquoeducationactivitiesshouldbe conductedunder thedirectionofa qualifieddiabetes healthcare professionalsuchas adiabeteseducatorwhohastrainingandexpertisein areasrelative todirectcare andongoing supportservices

3 Please elaborate on the roles of CHWs in diabetes education

According to AADECHWsarerecognizedasDiabetesParaprofessionalLevel1 TheCHWshouldbetrainedbya diabetes healthcareprofessional whounderstands evidence‐basedguidelinesfordiabetes education Formoreinformationonthe rolesofadiabeteseducatorassociatepleasesee Community Health Workers in Diabetes Management and Prevention and Diabetes Educator Practice Levels

4 How are CHWs being perceived by ADA or AADE programs for the delivery of DSMEADArecentlyreachedo uttoafewprogramsthathaveindicated theyareusingparaprofessionalorCHWsintheirrecogniz edD SMEprogramsThep araprofessionaleducatordataentrypointwasaddedinJanuary2014soallpro gramsthatare usingparaprofessionalsandCHWshave notrenew edtheir4‐yearrecognitioncyclesincethisinitiationA DAhopesthattheird ataandcontactswillbemore robustastimepassesmdash especiallybyJanuary2018

Please see the following comment from a recognized program reflecting how ADA programs are incorporating CHWs

ldquoAsweallknowwithdiabetescomesotherissueshypertension andhyperlipidemiaamong otherswherecost for diabetescarecan bereallyexpensiveeven withinsuranceButforindividualswhodonothaveinsurance orareunderinsuredCHWshaveacommunityresourcebankthatisused toprovideadditionalresourcestofolkswhomayneed assistancewithobtainingamedicalhomemedications an electricbill makingappointments orfillingoutapplicationsTheCHWswillalsofollowupwithfolkswhohavealreadyattended classtoensureunderstandingofmealplanning carbcountingandbenefitsof physicalactivityorimportanceoftakingmedications asprescribedTheywill reinforceeducationthat hasalready beentaughtbyacertifieddiabetes educator(CDE) registerednurseregistered dietitianor nutritionistCHWsbreakbarrierstounderstanding andobtainingneeded resourcesinorderfor individualstocontrol their diabetesand ultimatelylivehealthierlivesrdquo

AADErecentlypostedtheirpracticesynopsis onCHWsin whichtheyrecognized that

ldquoIndividuals who serve as lay health and CHWs and peer counselors or educators maycontribute to the provision of DSME instruction and provide DSMS if they have

4

received training in diabetes management the teaching of self‐management skills groupfacilitationandemotionalsupportrdquo2

5 Can a CHW be trained in the Stanford Model Diabetes Self‐Management EducationYesAslongasCHWistrainedand certifiedto facilitate StanfordprogramsCHWsalsohave beencertifiedasStanfordCDSMP ldquomastertrainersrdquoMoreinformationontrainingsisavailable at Stanford DiabetesSelf‐Management Programtrainings

Rolesrelatedtospecificdiseasesandconditions 1 Are there any CHW programs serving people living alone with dementiaWe are not aware of any programs specificallyworkingwithsuch individualsCHWsdonotserve asdirectcareproviders whichwouldseemtobeabasic need inthissituationAneighborhood‐basedvolunteerefforttomeetthoseneedswouldseemlikeagoodidea CHWscandefinitelyhelpwithnonmedicalnon‐directcare issuesincluding caregiversupportwhich canenableanindividualtoremainathomelongerSeethefollowingexamples whereCHWsplayedarolewiththispopulation

The Care Span Medicaid Savings Resulted When Community Health Workers Matched Those with Needs to Home and Community Care

Feasibility and Validity of Dementia Assessment by Trained Community Health Workers based on Clinical Dementia Rating

Identification of dementia cases in the community A Brazilian experience Role of Community Health Workers in Dementia Case Finding

2 How do I get the studies showing benefits of CHW work on cardiovascular diseases (CVD)Gotothe GuidetoCommunityPreventiveServicesmdasha freeresourcemdashtohelpyouchooseprogramsandpolicies toimprove healthand preventdisease in the community Systematicreviewsareusedtoanswerthe followingquestions

Whichprogramandpolicyinterventionshavebeenproveneffective Arethereeffective int erventionst hatarerigh t formycommunity WhatmighteffectiveinterventionscostWhatisthelikelyreturnoni nvestment

The Cardiovascular Disease Prevention and Control Interventions Engaging Community Health Workers tableshows interventionsthatengageCHWsin preventing CVDThere isldquostrongevidencerdquoof effectivenessfor interventionsthatengageCHWsinateam‐basedcaremodeltoimprovebloodpressureandcholesterolinpatients atincreased risk for CVD There isldquosufficient evidencerdquoof effectiveness forinterventionsthat engageCHWsforhealtheducation andasoutreachenrollmentand informationagentstoincrease self‐reportedhealthbehaviors

2 American Association of Diabetes Educators Community Health Workers in Diabetes Management and Prevention AADE Practice Synopsis June 4 2015 Page 1

5

(iephysicalactivity healthfuleatinghabits andsmoking cessation) inpatients atincreased riskfor CVD

Thefollowinglistincludessomeotherexampleswhere CHWscan playaroleinCVD

Community Health Workers as Interventionists in the Prevention and Control of Heart Disease and Stroke

The Effectiveness of a Community Health Worker Outreach Program on Healthcare Utilization of West Baltimore City Medicaid Patients with Diabetes With or Without Hypertension

Linking Community‐Based Blood Pressure Measurement to Clinical Care a Randomized Controlled Trial of Outreach and Tracking by Community Health Workers

For the Patient Community Health Workers Help to Reduce High Blood Pressure

3 Do you have CHWs that are specifically focused on maternal child health and women of childbearing age

TheNavajo BirthCohortStudyincludescommunityhealthrepresentatives(CHRs)orCHWsthatarefocusedonrecruitingwomenofchildbearing ageThis isthefirstprospectiveepidemiologicstudyof pregnancy andneonataloutcomesinauranium‐exposedpopulationCHRsalsoprovide education andoutreachregardinguraniumexposureprenatalcareand maternalchildhealth3 CHRsareAmerican Indianparaprofessionalhealthcareproviders4

CDCrsquosDivisionofReproductiveHealthcurrentlyfundstheSouth Carolina CampaigntoPrevent TeenPregnancy5 thatusesaCHWtoaddressteen pregnancypreventionTheCHW engageswithneighborsandtheirchildrenindividuallyandsometimesin groupstoshare informationaboutlocal clinicsandotherresourcestoencourageparentandchildcommunicationand toraiseawarenessof theimportance ofpreventingteenpregnanciesamongsexuallyactiveteens living inher community

4 How can we [grantees] work with CHWs in a cancer screening program (colorectal cancer) How can we work with CHWs to assist them in documenting their work

CHWscanhelpidentify ldquohard‐to‐reachrdquoindividualsinneed ofbreastcervicalandcolorectalcancerscreeningandlinkthemto healthcare systemswheretheseservices are availableGranteescansupportCHWprogramsinavarietyofways(egfundingforCHWprogramstechnicalassistancesupportfor CHWtraining)Itisimportantfor CHWprogramsto documentservice deliveryandintendedoutcomesGranteescanprovidetechnicalassistance

3 ATSDR Navajo Birth Cohort Study website httpwwwatsdrcdcgovsitesnavajo_birth_cohort_studyindexhtml Accessed February 22 2016 4 Indian Health Service Community Health Representatives website httpwwwihsgovchrindexcfm Accessed February 22 2016 5 South Carolina Campaign to Prevent Teen Pregnancy Teen Pregnancy Prevention website wwwteenpregnancyscorg Accessed February 11 2016

6

betweenhealthservicesorsocialservicesand thecommunity to facilitate access toservicesandimprovethequalityandculturalcompetenceofservicedeliveryCHWsalsobuildindividualandcommunitycapacity byincreasinghealthknowledge andself‐sufficiency througharangeof activitiessuchasoutreachcommunityeducationinformalcounselingsocialsupportand advocacy

Traditionallynon‐clinicallytrainedCHWshavebeenusedprimarily inanoutreachcapacityprovidingtopic‐specifichealtheducationcommunityadvocacyandempowermentresourcesocialserviceconnectionandreferralandcoordinationofcommunityeventssuchashealthfairsandscreeningsPerhapsmostimportantlyCHWrsquosuniqueunderstandingof thechallengesfacingtheir community allowsthemtofunctionasldquobarrierbustersrdquo tohelpcommunitymembersappropriately accessandusehealth careservices

Patientnavigatorsare workerstrained tohelppatientsldquonavigaterdquotheirway throughthecomplexandfragmentedhealthcaresystemTheyoffer arangeofservices(eg providesocialserviceandresourceinformation assist withhealth and insuranceformsfindtransportationalternativesmake connection tospecialty healthcare)Whilenavigatorsactasthoughtfulandinformedguides throughtheoftenconfusingandoverwhelmingmazeofhealthcare servicestheirroles typicallydonotencompasshealthpromotioneducationdiseaseself‐managementcoaching individual andcommunity advocacyorhealthequity

Althoughthereisnorequirement thatapatientnavigator bea communityhealth representative(CHR)itcouldbearguedthatthebestnavigatorwillalsobeaCHWThepersonalcharacteristics ofaCHWmaymorereadily facilitate a trustingrelationshipandanopendialogueaboutthebarriers andchallengespreventingpatients fromreceivingthe healthcare theyneed Knowing andunderstanding thosebarriers willenabletheCHWtohelpthepatientnavigate thesystemandreceivethoseservicesInadditionaCHW bringstotheroleof navigator theunderstandingof theimportanceofpatientadvocacyandempowerment inimprovinganindividualrsquosabilitytomanagetheirhealth

Ontheotherhandmanypatient navigatorprogramsemploynursesor socialworkersinthe navigator roleThisis alegitimate designchoiceanddoes not inanywaydiminishthevalueorcontributionofthe patientnavigator

2 What roles do CHWs play in clinical settings throughout the United States

AlthoughCHWsrsquorolesvarydependingonlocalandculturalsettings theymostoften arefoundworkinginunderprivileged marginalizedcommunitieswhere peoplemayhavelimitedresourceslackaccessto qualityhealthcarelackthe meanstopayforhealthcarenotspeakEnglishfluentlyorhave culturalbeliefs values andbehaviorsdifferentfromthoseofthedominantwestern‐typeofhealth caresystemInthese communitiesCHWsplayanintegralroleinhelpingsystemsbecomemoreculturallyappropriateandrelevanttothepeoplethesystemstheyserve

2

CHWstypicallyhavedeeprootsor sharedlife experiences inthecommunities theyserve Theyshare similarvaluesethnicbackground andsocioeconomic statusandusuallythesamelanguageas thepeopletheyserve ThusCHWactsasabridgebetweenthe communityandthehealthcaregovernment andsocialservicesystems

ResponsibilitiesofCHWsinclinicalsettings mightincludeto

Helpindividualsfamiliesgroupsandcommunit iesdeveloptheircapacityandaccesstoresourcesincludinghealth insurancefoodhousingqualityc areand healthinformation

Facilitatecommunicationandclientempowermentininteractions withhealthcareorsocialservicesystems

Helphealthcareandsocialservicesystemsbecomeculturallyr elevantandresponsivet otheirservicepopulation

Helppeopleunderstand theirhealthconditionsanddevelopstrategiestoimprove theirhealthandwell‐being

Helpbuild understandingandsocialcapitaltosupporthealthierbehaviorsand lifestylechoices

Deliverhealthinformationusing culturallyappropriatetermsandconcepts Linkpeopletohealthcareorsocialservice r esources Provideinformalcounselingsupportandfollow‐up Advocatefor localhealthneeds Providehealthservices(egbloodpressuremonitor ingfir staidaccess) Makehomevisitstochronicallyillpatientspr egnantwomennursingmothersindividualsathighrisk o fhealthproblemsandtheelderly

Translatea ndinterpretforclientsandhealth c areorsocialservice providersTheyshouldonlybeexpectedtodosoiftheyareseparatelyandpro fessionallytrainedfor theseduties

Rolesof CHWsinDiabetesSelf‐ManagementEducation 1 Can Diabetes Self‐Management Education (DSME) be facilitated by CHWsHistoricallynursesand dietitians were themainprovidersof diabeteseducationReflecting theevolving healthcare environmenta numberofstudieshave endorsedamultidisciplinaryteamapproachtodiabetescareeducationandsupportRecentlylayhealthandcommunityhealthworkersandpeercounselorsoreducators(amongothers) havebeenshowntocontribute effectivelyaspartoftheDSMEteamandinprovidingDSMETheAmericanAssociationofDiabetesEducators(AADE)endorsedsignificant rolesforCHWsinDSME1

2 Will CHWs need to work under the direction of a provider in order to teach DSME

1 American Association of Diabetes Educators A Sustainable Model of Diabetes Self‐Management EducationTraining Involves a Multi‐Level Team That Can Include Community Health Workers Chicago IL AADE

3

Accordingtothe CommunityHealth Workersin Diabetes Management andPrevention AADEPractice SynopsisCHWsrsquoeducationactivitiesshouldbe conductedunder thedirectionofa qualifieddiabetes healthcare professionalsuchas adiabeteseducatorwhohastrainingandexpertisein areasrelative todirectcare andongoing supportservices

3 Please elaborate on the roles of CHWs in diabetes education

According to AADECHWsarerecognizedasDiabetesParaprofessionalLevel1 TheCHWshouldbetrainedbya diabetes healthcareprofessional whounderstands evidence‐basedguidelinesfordiabetes education Formoreinformationonthe rolesofadiabeteseducatorassociatepleasesee Community Health Workers in Diabetes Management and Prevention and Diabetes Educator Practice Levels

4 How are CHWs being perceived by ADA or AADE programs for the delivery of DSMEADArecentlyreachedo uttoafewprogramsthathaveindicated theyareusingparaprofessionalorCHWsintheirrecogniz edD SMEprogramsThep araprofessionaleducatordataentrypointwasaddedinJanuary2014soallpro gramsthatare usingparaprofessionalsandCHWshave notrenew edtheir4‐yearrecognitioncyclesincethisinitiationA DAhopesthattheird ataandcontactswillbemore robustastimepassesmdash especiallybyJanuary2018

Please see the following comment from a recognized program reflecting how ADA programs are incorporating CHWs

ldquoAsweallknowwithdiabetescomesotherissueshypertension andhyperlipidemiaamong otherswherecost for diabetescarecan bereallyexpensiveeven withinsuranceButforindividualswhodonothaveinsurance orareunderinsuredCHWshaveacommunityresourcebankthatisused toprovideadditionalresourcestofolkswhomayneed assistancewithobtainingamedicalhomemedications an electricbill makingappointments orfillingoutapplicationsTheCHWswillalsofollowupwithfolkswhohavealreadyattended classtoensureunderstandingofmealplanning carbcountingandbenefitsof physicalactivityorimportanceoftakingmedications asprescribedTheywill reinforceeducationthat hasalready beentaughtbyacertifieddiabetes educator(CDE) registerednurseregistered dietitianor nutritionistCHWsbreakbarrierstounderstanding andobtainingneeded resourcesinorderfor individualstocontrol their diabetesand ultimatelylivehealthierlivesrdquo

AADErecentlypostedtheirpracticesynopsis onCHWsin whichtheyrecognized that

ldquoIndividuals who serve as lay health and CHWs and peer counselors or educators maycontribute to the provision of DSME instruction and provide DSMS if they have

4

received training in diabetes management the teaching of self‐management skills groupfacilitationandemotionalsupportrdquo2

5 Can a CHW be trained in the Stanford Model Diabetes Self‐Management EducationYesAslongasCHWistrainedand certifiedto facilitate StanfordprogramsCHWsalsohave beencertifiedasStanfordCDSMP ldquomastertrainersrdquoMoreinformationontrainingsisavailable at Stanford DiabetesSelf‐Management Programtrainings

Rolesrelatedtospecificdiseasesandconditions 1 Are there any CHW programs serving people living alone with dementiaWe are not aware of any programs specificallyworkingwithsuch individualsCHWsdonotserve asdirectcareproviders whichwouldseemtobeabasic need inthissituationAneighborhood‐basedvolunteerefforttomeetthoseneedswouldseemlikeagoodidea CHWscandefinitelyhelpwithnonmedicalnon‐directcare issuesincluding caregiversupportwhich canenableanindividualtoremainathomelongerSeethefollowingexamples whereCHWsplayedarolewiththispopulation

The Care Span Medicaid Savings Resulted When Community Health Workers Matched Those with Needs to Home and Community Care

Feasibility and Validity of Dementia Assessment by Trained Community Health Workers based on Clinical Dementia Rating

Identification of dementia cases in the community A Brazilian experience Role of Community Health Workers in Dementia Case Finding

2 How do I get the studies showing benefits of CHW work on cardiovascular diseases (CVD)Gotothe GuidetoCommunityPreventiveServicesmdasha freeresourcemdashtohelpyouchooseprogramsandpolicies toimprove healthand preventdisease in the community Systematicreviewsareusedtoanswerthe followingquestions

Whichprogramandpolicyinterventionshavebeenproveneffective Arethereeffective int erventionst hatarerigh t formycommunity WhatmighteffectiveinterventionscostWhatisthelikelyreturnoni nvestment

The Cardiovascular Disease Prevention and Control Interventions Engaging Community Health Workers tableshows interventionsthatengageCHWsin preventing CVDThere isldquostrongevidencerdquoof effectivenessfor interventionsthatengageCHWsinateam‐basedcaremodeltoimprovebloodpressureandcholesterolinpatients atincreased risk for CVD There isldquosufficient evidencerdquoof effectiveness forinterventionsthat engageCHWsforhealtheducation andasoutreachenrollmentand informationagentstoincrease self‐reportedhealthbehaviors

2 American Association of Diabetes Educators Community Health Workers in Diabetes Management and Prevention AADE Practice Synopsis June 4 2015 Page 1

5

(iephysicalactivity healthfuleatinghabits andsmoking cessation) inpatients atincreased riskfor CVD

Thefollowinglistincludessomeotherexampleswhere CHWscan playaroleinCVD

Community Health Workers as Interventionists in the Prevention and Control of Heart Disease and Stroke

The Effectiveness of a Community Health Worker Outreach Program on Healthcare Utilization of West Baltimore City Medicaid Patients with Diabetes With or Without Hypertension

Linking Community‐Based Blood Pressure Measurement to Clinical Care a Randomized Controlled Trial of Outreach and Tracking by Community Health Workers

For the Patient Community Health Workers Help to Reduce High Blood Pressure

3 Do you have CHWs that are specifically focused on maternal child health and women of childbearing age

TheNavajo BirthCohortStudyincludescommunityhealthrepresentatives(CHRs)orCHWsthatarefocusedonrecruitingwomenofchildbearing ageThis isthefirstprospectiveepidemiologicstudyof pregnancy andneonataloutcomesinauranium‐exposedpopulationCHRsalsoprovide education andoutreachregardinguraniumexposureprenatalcareand maternalchildhealth3 CHRsareAmerican Indianparaprofessionalhealthcareproviders4

CDCrsquosDivisionofReproductiveHealthcurrentlyfundstheSouth Carolina CampaigntoPrevent TeenPregnancy5 thatusesaCHWtoaddressteen pregnancypreventionTheCHW engageswithneighborsandtheirchildrenindividuallyandsometimesin groupstoshare informationaboutlocal clinicsandotherresourcestoencourageparentandchildcommunicationand toraiseawarenessof theimportance ofpreventingteenpregnanciesamongsexuallyactiveteens living inher community

4 How can we [grantees] work with CHWs in a cancer screening program (colorectal cancer) How can we work with CHWs to assist them in documenting their work

CHWscanhelpidentify ldquohard‐to‐reachrdquoindividualsinneed ofbreastcervicalandcolorectalcancerscreeningandlinkthemto healthcare systemswheretheseservices are availableGranteescansupportCHWprogramsinavarietyofways(egfundingforCHWprogramstechnicalassistancesupportfor CHWtraining)Itisimportantfor CHWprogramsto documentservice deliveryandintendedoutcomesGranteescanprovidetechnicalassistance

3 ATSDR Navajo Birth Cohort Study website httpwwwatsdrcdcgovsitesnavajo_birth_cohort_studyindexhtml Accessed February 22 2016 4 Indian Health Service Community Health Representatives website httpwwwihsgovchrindexcfm Accessed February 22 2016 5 South Carolina Campaign to Prevent Teen Pregnancy Teen Pregnancy Prevention website wwwteenpregnancyscorg Accessed February 11 2016

6

CHWstypicallyhavedeeprootsor sharedlife experiences inthecommunities theyserve Theyshare similarvaluesethnicbackground andsocioeconomic statusandusuallythesamelanguageas thepeopletheyserve ThusCHWactsasabridgebetweenthe communityandthehealthcaregovernment andsocialservicesystems

ResponsibilitiesofCHWsinclinicalsettings mightincludeto

Helpindividualsfamiliesgroupsandcommunit iesdeveloptheircapacityandaccesstoresourcesincludinghealth insurancefoodhousingqualityc areand healthinformation

Facilitatecommunicationandclientempowermentininteractions withhealthcareorsocialservicesystems

Helphealthcareandsocialservicesystemsbecomeculturallyr elevantandresponsivet otheirservicepopulation

Helppeopleunderstand theirhealthconditionsanddevelopstrategiestoimprove theirhealthandwell‐being

Helpbuild understandingandsocialcapitaltosupporthealthierbehaviorsand lifestylechoices

Deliverhealthinformationusing culturallyappropriatetermsandconcepts Linkpeopletohealthcareorsocialservice r esources Provideinformalcounselingsupportandfollow‐up Advocatefor localhealthneeds Providehealthservices(egbloodpressuremonitor ingfir staidaccess) Makehomevisitstochronicallyillpatientspr egnantwomennursingmothersindividualsathighrisk o fhealthproblemsandtheelderly

Translatea ndinterpretforclientsandhealth c areorsocialservice providersTheyshouldonlybeexpectedtodosoiftheyareseparatelyandpro fessionallytrainedfor theseduties

Rolesof CHWsinDiabetesSelf‐ManagementEducation 1 Can Diabetes Self‐Management Education (DSME) be facilitated by CHWsHistoricallynursesand dietitians were themainprovidersof diabeteseducationReflecting theevolving healthcare environmenta numberofstudieshave endorsedamultidisciplinaryteamapproachtodiabetescareeducationandsupportRecentlylayhealthandcommunityhealthworkersandpeercounselorsoreducators(amongothers) havebeenshowntocontribute effectivelyaspartoftheDSMEteamandinprovidingDSMETheAmericanAssociationofDiabetesEducators(AADE)endorsedsignificant rolesforCHWsinDSME1

2 Will CHWs need to work under the direction of a provider in order to teach DSME

1 American Association of Diabetes Educators A Sustainable Model of Diabetes Self‐Management EducationTraining Involves a Multi‐Level Team That Can Include Community Health Workers Chicago IL AADE

3

Accordingtothe CommunityHealth Workersin Diabetes Management andPrevention AADEPractice SynopsisCHWsrsquoeducationactivitiesshouldbe conductedunder thedirectionofa qualifieddiabetes healthcare professionalsuchas adiabeteseducatorwhohastrainingandexpertisein areasrelative todirectcare andongoing supportservices

3 Please elaborate on the roles of CHWs in diabetes education

According to AADECHWsarerecognizedasDiabetesParaprofessionalLevel1 TheCHWshouldbetrainedbya diabetes healthcareprofessional whounderstands evidence‐basedguidelinesfordiabetes education Formoreinformationonthe rolesofadiabeteseducatorassociatepleasesee Community Health Workers in Diabetes Management and Prevention and Diabetes Educator Practice Levels

4 How are CHWs being perceived by ADA or AADE programs for the delivery of DSMEADArecentlyreachedo uttoafewprogramsthathaveindicated theyareusingparaprofessionalorCHWsintheirrecogniz edD SMEprogramsThep araprofessionaleducatordataentrypointwasaddedinJanuary2014soallpro gramsthatare usingparaprofessionalsandCHWshave notrenew edtheir4‐yearrecognitioncyclesincethisinitiationA DAhopesthattheird ataandcontactswillbemore robustastimepassesmdash especiallybyJanuary2018

Please see the following comment from a recognized program reflecting how ADA programs are incorporating CHWs

ldquoAsweallknowwithdiabetescomesotherissueshypertension andhyperlipidemiaamong otherswherecost for diabetescarecan bereallyexpensiveeven withinsuranceButforindividualswhodonothaveinsurance orareunderinsuredCHWshaveacommunityresourcebankthatisused toprovideadditionalresourcestofolkswhomayneed assistancewithobtainingamedicalhomemedications an electricbill makingappointments orfillingoutapplicationsTheCHWswillalsofollowupwithfolkswhohavealreadyattended classtoensureunderstandingofmealplanning carbcountingandbenefitsof physicalactivityorimportanceoftakingmedications asprescribedTheywill reinforceeducationthat hasalready beentaughtbyacertifieddiabetes educator(CDE) registerednurseregistered dietitianor nutritionistCHWsbreakbarrierstounderstanding andobtainingneeded resourcesinorderfor individualstocontrol their diabetesand ultimatelylivehealthierlivesrdquo

AADErecentlypostedtheirpracticesynopsis onCHWsin whichtheyrecognized that

ldquoIndividuals who serve as lay health and CHWs and peer counselors or educators maycontribute to the provision of DSME instruction and provide DSMS if they have

4

received training in diabetes management the teaching of self‐management skills groupfacilitationandemotionalsupportrdquo2

5 Can a CHW be trained in the Stanford Model Diabetes Self‐Management EducationYesAslongasCHWistrainedand certifiedto facilitate StanfordprogramsCHWsalsohave beencertifiedasStanfordCDSMP ldquomastertrainersrdquoMoreinformationontrainingsisavailable at Stanford DiabetesSelf‐Management Programtrainings

Rolesrelatedtospecificdiseasesandconditions 1 Are there any CHW programs serving people living alone with dementiaWe are not aware of any programs specificallyworkingwithsuch individualsCHWsdonotserve asdirectcareproviders whichwouldseemtobeabasic need inthissituationAneighborhood‐basedvolunteerefforttomeetthoseneedswouldseemlikeagoodidea CHWscandefinitelyhelpwithnonmedicalnon‐directcare issuesincluding caregiversupportwhich canenableanindividualtoremainathomelongerSeethefollowingexamples whereCHWsplayedarolewiththispopulation

The Care Span Medicaid Savings Resulted When Community Health Workers Matched Those with Needs to Home and Community Care

Feasibility and Validity of Dementia Assessment by Trained Community Health Workers based on Clinical Dementia Rating

Identification of dementia cases in the community A Brazilian experience Role of Community Health Workers in Dementia Case Finding

2 How do I get the studies showing benefits of CHW work on cardiovascular diseases (CVD)Gotothe GuidetoCommunityPreventiveServicesmdasha freeresourcemdashtohelpyouchooseprogramsandpolicies toimprove healthand preventdisease in the community Systematicreviewsareusedtoanswerthe followingquestions

Whichprogramandpolicyinterventionshavebeenproveneffective Arethereeffective int erventionst hatarerigh t formycommunity WhatmighteffectiveinterventionscostWhatisthelikelyreturnoni nvestment

The Cardiovascular Disease Prevention and Control Interventions Engaging Community Health Workers tableshows interventionsthatengageCHWsin preventing CVDThere isldquostrongevidencerdquoof effectivenessfor interventionsthatengageCHWsinateam‐basedcaremodeltoimprovebloodpressureandcholesterolinpatients atincreased risk for CVD There isldquosufficient evidencerdquoof effectiveness forinterventionsthat engageCHWsforhealtheducation andasoutreachenrollmentand informationagentstoincrease self‐reportedhealthbehaviors

2 American Association of Diabetes Educators Community Health Workers in Diabetes Management and Prevention AADE Practice Synopsis June 4 2015 Page 1

5

(iephysicalactivity healthfuleatinghabits andsmoking cessation) inpatients atincreased riskfor CVD

Thefollowinglistincludessomeotherexampleswhere CHWscan playaroleinCVD

Community Health Workers as Interventionists in the Prevention and Control of Heart Disease and Stroke

The Effectiveness of a Community Health Worker Outreach Program on Healthcare Utilization of West Baltimore City Medicaid Patients with Diabetes With or Without Hypertension

Linking Community‐Based Blood Pressure Measurement to Clinical Care a Randomized Controlled Trial of Outreach and Tracking by Community Health Workers

For the Patient Community Health Workers Help to Reduce High Blood Pressure

3 Do you have CHWs that are specifically focused on maternal child health and women of childbearing age

TheNavajo BirthCohortStudyincludescommunityhealthrepresentatives(CHRs)orCHWsthatarefocusedonrecruitingwomenofchildbearing ageThis isthefirstprospectiveepidemiologicstudyof pregnancy andneonataloutcomesinauranium‐exposedpopulationCHRsalsoprovide education andoutreachregardinguraniumexposureprenatalcareand maternalchildhealth3 CHRsareAmerican Indianparaprofessionalhealthcareproviders4

CDCrsquosDivisionofReproductiveHealthcurrentlyfundstheSouth Carolina CampaigntoPrevent TeenPregnancy5 thatusesaCHWtoaddressteen pregnancypreventionTheCHW engageswithneighborsandtheirchildrenindividuallyandsometimesin groupstoshare informationaboutlocal clinicsandotherresourcestoencourageparentandchildcommunicationand toraiseawarenessof theimportance ofpreventingteenpregnanciesamongsexuallyactiveteens living inher community

4 How can we [grantees] work with CHWs in a cancer screening program (colorectal cancer) How can we work with CHWs to assist them in documenting their work

CHWscanhelpidentify ldquohard‐to‐reachrdquoindividualsinneed ofbreastcervicalandcolorectalcancerscreeningandlinkthemto healthcare systemswheretheseservices are availableGranteescansupportCHWprogramsinavarietyofways(egfundingforCHWprogramstechnicalassistancesupportfor CHWtraining)Itisimportantfor CHWprogramsto documentservice deliveryandintendedoutcomesGranteescanprovidetechnicalassistance

3 ATSDR Navajo Birth Cohort Study website httpwwwatsdrcdcgovsitesnavajo_birth_cohort_studyindexhtml Accessed February 22 2016 4 Indian Health Service Community Health Representatives website httpwwwihsgovchrindexcfm Accessed February 22 2016 5 South Carolina Campaign to Prevent Teen Pregnancy Teen Pregnancy Prevention website wwwteenpregnancyscorg Accessed February 11 2016

6

Accordingtothe CommunityHealth Workersin Diabetes Management andPrevention AADEPractice SynopsisCHWsrsquoeducationactivitiesshouldbe conductedunder thedirectionofa qualifieddiabetes healthcare professionalsuchas adiabeteseducatorwhohastrainingandexpertisein areasrelative todirectcare andongoing supportservices

3 Please elaborate on the roles of CHWs in diabetes education

According to AADECHWsarerecognizedasDiabetesParaprofessionalLevel1 TheCHWshouldbetrainedbya diabetes healthcareprofessional whounderstands evidence‐basedguidelinesfordiabetes education Formoreinformationonthe rolesofadiabeteseducatorassociatepleasesee Community Health Workers in Diabetes Management and Prevention and Diabetes Educator Practice Levels

4 How are CHWs being perceived by ADA or AADE programs for the delivery of DSMEADArecentlyreachedo uttoafewprogramsthathaveindicated theyareusingparaprofessionalorCHWsintheirrecogniz edD SMEprogramsThep araprofessionaleducatordataentrypointwasaddedinJanuary2014soallpro gramsthatare usingparaprofessionalsandCHWshave notrenew edtheir4‐yearrecognitioncyclesincethisinitiationA DAhopesthattheird ataandcontactswillbemore robustastimepassesmdash especiallybyJanuary2018

Please see the following comment from a recognized program reflecting how ADA programs are incorporating CHWs

ldquoAsweallknowwithdiabetescomesotherissueshypertension andhyperlipidemiaamong otherswherecost for diabetescarecan bereallyexpensiveeven withinsuranceButforindividualswhodonothaveinsurance orareunderinsuredCHWshaveacommunityresourcebankthatisused toprovideadditionalresourcestofolkswhomayneed assistancewithobtainingamedicalhomemedications an electricbill makingappointments orfillingoutapplicationsTheCHWswillalsofollowupwithfolkswhohavealreadyattended classtoensureunderstandingofmealplanning carbcountingandbenefitsof physicalactivityorimportanceoftakingmedications asprescribedTheywill reinforceeducationthat hasalready beentaughtbyacertifieddiabetes educator(CDE) registerednurseregistered dietitianor nutritionistCHWsbreakbarrierstounderstanding andobtainingneeded resourcesinorderfor individualstocontrol their diabetesand ultimatelylivehealthierlivesrdquo

AADErecentlypostedtheirpracticesynopsis onCHWsin whichtheyrecognized that

ldquoIndividuals who serve as lay health and CHWs and peer counselors or educators maycontribute to the provision of DSME instruction and provide DSMS if they have

4

received training in diabetes management the teaching of self‐management skills groupfacilitationandemotionalsupportrdquo2

5 Can a CHW be trained in the Stanford Model Diabetes Self‐Management EducationYesAslongasCHWistrainedand certifiedto facilitate StanfordprogramsCHWsalsohave beencertifiedasStanfordCDSMP ldquomastertrainersrdquoMoreinformationontrainingsisavailable at Stanford DiabetesSelf‐Management Programtrainings

Rolesrelatedtospecificdiseasesandconditions 1 Are there any CHW programs serving people living alone with dementiaWe are not aware of any programs specificallyworkingwithsuch individualsCHWsdonotserve asdirectcareproviders whichwouldseemtobeabasic need inthissituationAneighborhood‐basedvolunteerefforttomeetthoseneedswouldseemlikeagoodidea CHWscandefinitelyhelpwithnonmedicalnon‐directcare issuesincluding caregiversupportwhich canenableanindividualtoremainathomelongerSeethefollowingexamples whereCHWsplayedarolewiththispopulation

The Care Span Medicaid Savings Resulted When Community Health Workers Matched Those with Needs to Home and Community Care

Feasibility and Validity of Dementia Assessment by Trained Community Health Workers based on Clinical Dementia Rating

Identification of dementia cases in the community A Brazilian experience Role of Community Health Workers in Dementia Case Finding

2 How do I get the studies showing benefits of CHW work on cardiovascular diseases (CVD)Gotothe GuidetoCommunityPreventiveServicesmdasha freeresourcemdashtohelpyouchooseprogramsandpolicies toimprove healthand preventdisease in the community Systematicreviewsareusedtoanswerthe followingquestions

Whichprogramandpolicyinterventionshavebeenproveneffective Arethereeffective int erventionst hatarerigh t formycommunity WhatmighteffectiveinterventionscostWhatisthelikelyreturnoni nvestment

The Cardiovascular Disease Prevention and Control Interventions Engaging Community Health Workers tableshows interventionsthatengageCHWsin preventing CVDThere isldquostrongevidencerdquoof effectivenessfor interventionsthatengageCHWsinateam‐basedcaremodeltoimprovebloodpressureandcholesterolinpatients atincreased risk for CVD There isldquosufficient evidencerdquoof effectiveness forinterventionsthat engageCHWsforhealtheducation andasoutreachenrollmentand informationagentstoincrease self‐reportedhealthbehaviors

2 American Association of Diabetes Educators Community Health Workers in Diabetes Management and Prevention AADE Practice Synopsis June 4 2015 Page 1

5

(iephysicalactivity healthfuleatinghabits andsmoking cessation) inpatients atincreased riskfor CVD

Thefollowinglistincludessomeotherexampleswhere CHWscan playaroleinCVD

Community Health Workers as Interventionists in the Prevention and Control of Heart Disease and Stroke

The Effectiveness of a Community Health Worker Outreach Program on Healthcare Utilization of West Baltimore City Medicaid Patients with Diabetes With or Without Hypertension

Linking Community‐Based Blood Pressure Measurement to Clinical Care a Randomized Controlled Trial of Outreach and Tracking by Community Health Workers

For the Patient Community Health Workers Help to Reduce High Blood Pressure

3 Do you have CHWs that are specifically focused on maternal child health and women of childbearing age

TheNavajo BirthCohortStudyincludescommunityhealthrepresentatives(CHRs)orCHWsthatarefocusedonrecruitingwomenofchildbearing ageThis isthefirstprospectiveepidemiologicstudyof pregnancy andneonataloutcomesinauranium‐exposedpopulationCHRsalsoprovide education andoutreachregardinguraniumexposureprenatalcareand maternalchildhealth3 CHRsareAmerican Indianparaprofessionalhealthcareproviders4

CDCrsquosDivisionofReproductiveHealthcurrentlyfundstheSouth Carolina CampaigntoPrevent TeenPregnancy5 thatusesaCHWtoaddressteen pregnancypreventionTheCHW engageswithneighborsandtheirchildrenindividuallyandsometimesin groupstoshare informationaboutlocal clinicsandotherresourcestoencourageparentandchildcommunicationand toraiseawarenessof theimportance ofpreventingteenpregnanciesamongsexuallyactiveteens living inher community

4 How can we [grantees] work with CHWs in a cancer screening program (colorectal cancer) How can we work with CHWs to assist them in documenting their work

CHWscanhelpidentify ldquohard‐to‐reachrdquoindividualsinneed ofbreastcervicalandcolorectalcancerscreeningandlinkthemto healthcare systemswheretheseservices are availableGranteescansupportCHWprogramsinavarietyofways(egfundingforCHWprogramstechnicalassistancesupportfor CHWtraining)Itisimportantfor CHWprogramsto documentservice deliveryandintendedoutcomesGranteescanprovidetechnicalassistance

3 ATSDR Navajo Birth Cohort Study website httpwwwatsdrcdcgovsitesnavajo_birth_cohort_studyindexhtml Accessed February 22 2016 4 Indian Health Service Community Health Representatives website httpwwwihsgovchrindexcfm Accessed February 22 2016 5 South Carolina Campaign to Prevent Teen Pregnancy Teen Pregnancy Prevention website wwwteenpregnancyscorg Accessed February 11 2016

6

received training in diabetes management the teaching of self‐management skills groupfacilitationandemotionalsupportrdquo2

5 Can a CHW be trained in the Stanford Model Diabetes Self‐Management EducationYesAslongasCHWistrainedand certifiedto facilitate StanfordprogramsCHWsalsohave beencertifiedasStanfordCDSMP ldquomastertrainersrdquoMoreinformationontrainingsisavailable at Stanford DiabetesSelf‐Management Programtrainings

Rolesrelatedtospecificdiseasesandconditions 1 Are there any CHW programs serving people living alone with dementiaWe are not aware of any programs specificallyworkingwithsuch individualsCHWsdonotserve asdirectcareproviders whichwouldseemtobeabasic need inthissituationAneighborhood‐basedvolunteerefforttomeetthoseneedswouldseemlikeagoodidea CHWscandefinitelyhelpwithnonmedicalnon‐directcare issuesincluding caregiversupportwhich canenableanindividualtoremainathomelongerSeethefollowingexamples whereCHWsplayedarolewiththispopulation

The Care Span Medicaid Savings Resulted When Community Health Workers Matched Those with Needs to Home and Community Care

Feasibility and Validity of Dementia Assessment by Trained Community Health Workers based on Clinical Dementia Rating

Identification of dementia cases in the community A Brazilian experience Role of Community Health Workers in Dementia Case Finding

2 How do I get the studies showing benefits of CHW work on cardiovascular diseases (CVD)Gotothe GuidetoCommunityPreventiveServicesmdasha freeresourcemdashtohelpyouchooseprogramsandpolicies toimprove healthand preventdisease in the community Systematicreviewsareusedtoanswerthe followingquestions

Whichprogramandpolicyinterventionshavebeenproveneffective Arethereeffective int erventionst hatarerigh t formycommunity WhatmighteffectiveinterventionscostWhatisthelikelyreturnoni nvestment

The Cardiovascular Disease Prevention and Control Interventions Engaging Community Health Workers tableshows interventionsthatengageCHWsin preventing CVDThere isldquostrongevidencerdquoof effectivenessfor interventionsthatengageCHWsinateam‐basedcaremodeltoimprovebloodpressureandcholesterolinpatients atincreased risk for CVD There isldquosufficient evidencerdquoof effectiveness forinterventionsthat engageCHWsforhealtheducation andasoutreachenrollmentand informationagentstoincrease self‐reportedhealthbehaviors

2 American Association of Diabetes Educators Community Health Workers in Diabetes Management and Prevention AADE Practice Synopsis June 4 2015 Page 1

5

(iephysicalactivity healthfuleatinghabits andsmoking cessation) inpatients atincreased riskfor CVD

Thefollowinglistincludessomeotherexampleswhere CHWscan playaroleinCVD

Community Health Workers as Interventionists in the Prevention and Control of Heart Disease and Stroke

The Effectiveness of a Community Health Worker Outreach Program on Healthcare Utilization of West Baltimore City Medicaid Patients with Diabetes With or Without Hypertension

Linking Community‐Based Blood Pressure Measurement to Clinical Care a Randomized Controlled Trial of Outreach and Tracking by Community Health Workers

For the Patient Community Health Workers Help to Reduce High Blood Pressure

3 Do you have CHWs that are specifically focused on maternal child health and women of childbearing age

TheNavajo BirthCohortStudyincludescommunityhealthrepresentatives(CHRs)orCHWsthatarefocusedonrecruitingwomenofchildbearing ageThis isthefirstprospectiveepidemiologicstudyof pregnancy andneonataloutcomesinauranium‐exposedpopulationCHRsalsoprovide education andoutreachregardinguraniumexposureprenatalcareand maternalchildhealth3 CHRsareAmerican Indianparaprofessionalhealthcareproviders4

CDCrsquosDivisionofReproductiveHealthcurrentlyfundstheSouth Carolina CampaigntoPrevent TeenPregnancy5 thatusesaCHWtoaddressteen pregnancypreventionTheCHW engageswithneighborsandtheirchildrenindividuallyandsometimesin groupstoshare informationaboutlocal clinicsandotherresourcestoencourageparentandchildcommunicationand toraiseawarenessof theimportance ofpreventingteenpregnanciesamongsexuallyactiveteens living inher community

4 How can we [grantees] work with CHWs in a cancer screening program (colorectal cancer) How can we work with CHWs to assist them in documenting their work

CHWscanhelpidentify ldquohard‐to‐reachrdquoindividualsinneed ofbreastcervicalandcolorectalcancerscreeningandlinkthemto healthcare systemswheretheseservices are availableGranteescansupportCHWprogramsinavarietyofways(egfundingforCHWprogramstechnicalassistancesupportfor CHWtraining)Itisimportantfor CHWprogramsto documentservice deliveryandintendedoutcomesGranteescanprovidetechnicalassistance

3 ATSDR Navajo Birth Cohort Study website httpwwwatsdrcdcgovsitesnavajo_birth_cohort_studyindexhtml Accessed February 22 2016 4 Indian Health Service Community Health Representatives website httpwwwihsgovchrindexcfm Accessed February 22 2016 5 South Carolina Campaign to Prevent Teen Pregnancy Teen Pregnancy Prevention website wwwteenpregnancyscorg Accessed February 11 2016

6

(iephysicalactivity healthfuleatinghabits andsmoking cessation) inpatients atincreased riskfor CVD

Thefollowinglistincludessomeotherexampleswhere CHWscan playaroleinCVD

Community Health Workers as Interventionists in the Prevention and Control of Heart Disease and Stroke

The Effectiveness of a Community Health Worker Outreach Program on Healthcare Utilization of West Baltimore City Medicaid Patients with Diabetes With or Without Hypertension

Linking Community‐Based Blood Pressure Measurement to Clinical Care a Randomized Controlled Trial of Outreach and Tracking by Community Health Workers

For the Patient Community Health Workers Help to Reduce High Blood Pressure

3 Do you have CHWs that are specifically focused on maternal child health and women of childbearing age

TheNavajo BirthCohortStudyincludescommunityhealthrepresentatives(CHRs)orCHWsthatarefocusedonrecruitingwomenofchildbearing ageThis isthefirstprospectiveepidemiologicstudyof pregnancy andneonataloutcomesinauranium‐exposedpopulationCHRsalsoprovide education andoutreachregardinguraniumexposureprenatalcareand maternalchildhealth3 CHRsareAmerican Indianparaprofessionalhealthcareproviders4

CDCrsquosDivisionofReproductiveHealthcurrentlyfundstheSouth Carolina CampaigntoPrevent TeenPregnancy5 thatusesaCHWtoaddressteen pregnancypreventionTheCHW engageswithneighborsandtheirchildrenindividuallyandsometimesin groupstoshare informationaboutlocal clinicsandotherresourcestoencourageparentandchildcommunicationand toraiseawarenessof theimportance ofpreventingteenpregnanciesamongsexuallyactiveteens living inher community

4 How can we [grantees] work with CHWs in a cancer screening program (colorectal cancer) How can we work with CHWs to assist them in documenting their work

CHWscanhelpidentify ldquohard‐to‐reachrdquoindividualsinneed ofbreastcervicalandcolorectalcancerscreeningandlinkthemto healthcare systemswheretheseservices are availableGranteescansupportCHWprogramsinavarietyofways(egfundingforCHWprogramstechnicalassistancesupportfor CHWtraining)Itisimportantfor CHWprogramsto documentservice deliveryandintendedoutcomesGranteescanprovidetechnicalassistance

3 ATSDR Navajo Birth Cohort Study website httpwwwatsdrcdcgovsitesnavajo_birth_cohort_studyindexhtml Accessed February 22 2016 4 Indian Health Service Community Health Representatives website httpwwwihsgovchrindexcfm Accessed February 22 2016 5 South Carolina Campaign to Prevent Teen Pregnancy Teen Pregnancy Prevention website wwwteenpregnancyscorg Accessed February 11 2016

6

tosupportCHWprogramstodevelopeffectivemonitoring systems toassessprogramreach (egnumberofprioritypopulationreachedby CHWs)andaddress whethershort‐termoutcomesareachieved(egdopeoplereachedbytheCHWscompletescreening)

5 How do CHWs deal with Chronic Obstructive Pulmonary Disease (COPD) asthma or sleep apnea patients

TheNationalHeartLungandBloodInstitute(NHBLI)mdashinpartnershipwiththe National AsthmaEducationand Prevention ProgrammdashcreatedasthmaresourcesinSpanishand English Respirar es vida el control del asma en nuestros nintildeos (A Breath of Life Asthma Control for My Child) tohelpCHWsteacha six‐lessoncourseonasthmamanagement andcontrolto theLatinocommunityContentison thebasisoftheNHLBINational AsthmaEducationand Prevention Programs updated Guidelines for the Diagnosis and Management of AsthmaTheprogramincludesculturallyappropriateteachingscripts learningactivities and reproducible handoutsInteractiveactivities useroleplayproblem‐solving anddiscussiontohelpreinforce thematerialLatinorolemodels andfamilycontextsappearthroughout 6

RolesinDiabetesPrevention

1 How can CHWs become health coaches for our patients

Organizationsdelivering aDiabetesPrevention RecognitionProgramselectandhiretheirown lifestylecoachesCHWsinterested inworking withsuchorganizationscanalwayscontactan organization intheir areaThey donotneedtobeatrainedlifestylecoachpriorto contactinganorganizationas the organization maywishtosendtheiremployeestospecial training CHWscanfindDiabetes Prevention RecognitionProgramsandthe RegistryofRecognizedOrganizationsbystate onthe National DiabetesPrevention Program webpage

2 We are considering starting a Diabetes Prevention Program (DPP) program and want to know the role of CHWs in that setting Does the CDE oversee that personCHWscaneitherserveastheprogramcoordinatororthelifestylecoachThisisuptothesponsoringo rganizationthatisdeliveringt heNationalDiabetes Prev entionProgramTheNationalDiabetesPrev entionProgramorgan izationschoosetheirownstaffPleasesee AppendixC(page25)ofthe2015 Standards and Operating Procedures tohaveamore thoroughdescriptionoftheseroles

6 National Institutes of Health A Breath of Life Asthma Control for My Child‐ Respirar es vida el control del asma en nuestros nintildeos Bethesda Maryland US Department of Health and Human Services 2014 httpcatalognhlbinihgovcatalogproductA‐Breath‐of‐Life‐Asthma‐Control‐for‐My‐Child‐Respirar‐es‐vida‐el‐control‐del‐asma‐en‐nuestros‐ni‐os14‐7952 Accessed February 12 2016

7

Policy 1 Where can I find updated state legislation related to CHWsTheNationalAcademyforStateHealthPolicy(NASHP)websitefeaturesawealthofinformation concerning CHWsTheldquoState CHWLegislat ionrdquotabcontainslinkstospecificbillsandbillhistoriesandactionsbystateAlaskaasanexample hasstatutesrelatedtoldquocommunityhealthaiderdquogrants MinnesotalawallowsCHWstoparticipateinM edicaidprogramsandreceivepaymentforservices

TheAssociationofState and TerritorialHealth Officials(ASTHO)StateHealthPolicyTeamtracksstatelawconcerning CHWcertification standardsIllinoisfor exampleenactedalawthatprovidescertificationstandardsforCHWsAchartoutliningthesummariesofeachstatersquosCHWcertificationbillisalsoavailableVisit ASTHOrsquosCommunityHealthWorkerswebsite formoreCHWresources

Another resourceisthe NationalNetworkof PublicHealthInstitutes websiteSeveralpublic healthinnovationsmdashsuchastheInstitute forPublicHealthInnovationandHealth ResourcesinActionmdashareinvolvedinCHW‐relatedworkTheirwebsiteshave extensiveinformation

2 How have national policies (eg Patient Protection and Affordable Care Act Medicaid and immigration) affected the CHW field and health equityHealthreformasaresultofthe AffordableCareActisanopportunitytocreateamore equitablehealthcaresystemand addressdisparitiesi nhealthcare CHWsarer eceivinggreateratt entionconsideringtheir historicalcontributions in providingcommunity‐basedhealthservicestodisadvantaged andhard‐to‐reachpopulationsT he Affordable Care Act increasesaccesstoevidence‐base dpreventive healthcare underMedicaidand Medicare Thereisstr ongevidence thatsupportstheuseofCHWsforcardiovasculardisease prevention andcontrolmdashthe Community Preventive Services Task Force providesasummaryofthisevidence

OnJuly152013the Centersfor MedicareandMedicaidServicespublishedarulechangetitledldquoMedicaidandChildrensHealthInsuranceProgramsEssentialHealthBenefits inAlternative Benefit PlansEligibilityNoticesFairHearing andAppeal Processes andPremiumsandCost SharingExchanges EligibilityandEnrollmentrdquo Therulechange isoftenreferredto astheMedicaidPreventiveServicesRuleChangeThepurposeof therulechangeistoclarifywhocanprovideapreventive serviceunder a state Medicaidplan enablingcoverage and paymentwithfederal matchingfundsPreviouslypreventiveservicescouldonlybeprovidedbyaphysicianorother licensedpractitionerforMedicaid reimbursementNowstateshavetheoptiontoreimburselayproviders(egCHWs)thatprovide preventiveservices(asdefined byMedicaid)iftheservicesare recommendedbyaphysicianor otherlicensedpractitioner

Thischangeopensthe doortoCHWswhomeetapplicablestandards established bystateMedicaidprogramsFurthermore therulechangeoffers anopportunitytolower costsofhigh‐burdenconditionsand increase accesstopreventiveservicesfordisadvantaged communities

8

byusingCHWsForexamplecost‐effectiveness ofnursepractitioner andCHWteamsis discussedinthisarticlemdashldquoCost‐Effectivenessof NursePractitionerCommunityHealthWorkerCaretoReduceCardiovascularHealthDisparitiesrdquo J Cardiovasc Nurs Resourcesthatprovidemoreinformationinclude Update onPreventiveServices Initiatives and Medicaid Preventive Services Regulatory Change

Moredetail isavailable inthe articleldquoClinicalPreventiveServicesCoverageand theAffordable Care Actrdquo

Trustfor AmericarsquosHealthhasa policywebsitewithlinks to position statements andletters on varioustopics

FinancingandSustainability 1 How are CHWs compensated for their servicesTheNationalAcademyforStateHealthPolicyhasa StateCHWModelswebsite thatincludes sourcesofCHWfinancingbystate

Learnmoreat Medicaid Funding of Community‐Based Prevention Myths State Successes Overcoming Barriers and the Promise of Integrated Payment Models Prepared by Nemours

2 What is the official job code for CHWs Where can I find information on CHW wages and organizations that employ themTheDepartmentofLaborrecognizedCHWjobsasadistinctcategoryofemployment in2009TheStandardOccupationalClassificationcode forCHWsis 21‐1094(see BureauofLabor Statistics)

There are no thoroughnationalstudieson CHWwagesTheHealth ResourcesandServicesAdministration(HRSA)conducted anationalworkforcestudyin2007called Community Health Worker National Workforce Study butthisstudywasnotacomprehensiveassessmentandthe information isconsideredoutdated

There are variations in CHWwages basedonlocation(eg differences onthebasis oflocalcostoflivingconsiderations)InadditionactualCHWpositionsvaryinthelevelofskillrequiredNotallpositionsrequirethefullrangeof CHWcapabilities Forexamplethere aremanyldquooutreachworkerrdquojobsthataretypicallypaid less($1000‐$1200perhour)thanthoseworkingwithinhealth caremdashinsomecasesasmembersofpatient careteamswheretheymaybepaid$1500‐$2500 perhour

There areseverallocalstate andregionalstudiesthatincludecompensation‐relatedquestionsFindingsfrom onestudycanbefoundat Community Health Workers in the Midwest Understanding and Developing the Workforce

Itisnot knownwhetherthere are anystates withCHWcompensationpoliciesbesidesstategovernmentinternalhumanresourcessystemsSpecificstate‐fundedprogramssuchasMedicaidmayhaveestablished CHWwages7

9

3 How are CHW‐related interventions included in funded national prevention programsCDCrsquosNationalAsthma ControlProgram(NACP)fundsstatesandotherpartners toprovidetrainingeducationand surveillanceprogramsTheMassachusettsAsthmaPreventionandControlProgramworksonefforts tosustain asthmaclinicalcarethroughactivitiesaimedatincreasingthevoluntarycoveragebyinsurerssuchashomevisitsbyCHWsSeveralMassachusettsinsurers coverCHW in‐homeasthmaeducationand assessment Therearevariousresourcesdevelopedby NACP

CDCfunds otherchronicdiseaseprogramsinvolvingCHWsthrough cooperativeagreements Forasummaryof eachprogramvisit Addressing Chronic Disease Through Community Health Workers A Policy and Systems Approach

4 What are the recommendations for increasing the use of CHWsOfparticularimportance isthereco mmendationestablishedbytheCommunityPreventiveServicesTaskForceregardingevidencetosupporttheengagementofCHWsin a team‐basedcaremodeltopreventCVDFurtherevidencesupportstheirengagementtoimprovebloodpressureandcholesterolinpatientsatincreasedriskf orC VD ThedocumentCardiovascular Disease Prevention and Control Interventions Engaging Community Health Workers

Otherusefuldocumentsinclude

MillionHeartsfact sheet insupportofusingCHWs Addressing Chronic Disease Through CHWs A Policy and Systems‐Level Approachdeveloped byCDCrsquosNational Centerfor ChronicDisease PreventionandHealthPromotion Divisionfor HeartDiseaseandStrokePreventionprovidesguidanceandresourcesforimplementingrecommendationstouseCHWstoaddresschronichigh‐burdendiseasessuchasdiabetes andasthma

Optimizing Health Outcomes for Children with Asthma in DelawaredevelopedbyNemoursChildrenrsquosHealthSystemNemoursHealthamp Prevention ServicesThedocumenthighlightstheNemoursrsquo Optimizing HealthOutcomes(OHO)forChildren withAsthmainDelawareproject fundedbytheCentersfor Medicare amp Medicaidrsquos Innovation Center(CMMI)theInnovation CenterrsquosHealth CareInnovation Awards(HCIA)TheOHOprojecthighlightsinterdisciplinaryteam‐basedapproachestocareNinefull‐timeCHWseither inproviderpracticesortheNemoursAlfredIduPontHospitalfor Children inWilmingtonDelaware

ldquoCost‐Effectivenessof NursePractitionerCommunityHealthWorkerCare toReduceCardiovascular HealthDisparitiesrdquoIsanarticlethathighlightsthecost‐effectivenessofnursepractitionerorCHWteamstoreduceCVD disparitiesmdash

5 How do I address sustainability of the CHW workforceStayabreastofstatepolicyactions TheNationalAcademyfor StateHealthPolicy (NASHP) websiteisa nexcellentr esourceandfeaturesawealthofinfor mationconcerningCHWTheldquoStateC HWLegislationrdquotabcontainslinkstospecificbills andbillhistoriesa ndactionsby

10

stateAlaskaasan examplehasstatutesrelatedtoldquocommunityhealthaiderdquograntsMinnesotalawallowsCHWstoparticipatein Medicaidprogramsandreceive paymentforservices

TheASTHO StateHealth PolicyTeamtracksstatelawconcerning CHWcertificationstandardsTheStateofIllinoisfor exampleenactedalaw thatprovides certification standardsforCHWs Achartoutliningthesummariesof eachstatersquos CHWcertificationbillisalsoavailableLearn moreattheASTHO CHWresourcessite

StayabreastofCHWtrainingstandardsandcorecompetenciesTrainingcapacitybuildingpolicyandintegration resourcesaredetailedin Addressing Chronic Disease through Community Health Workers A Policy and Systems‐Level ApproachdevelopedbyCDCrsquosNationalCenter forChronicDiseasePreventionandHealthPromotionDivision forHeartDiseaseandStrokePreventionFinancingmechanismsforsustainableemploymentarealsooutlinedinthisdocument CHWservices are

Reimbursablebypublicpayers(egMedicaidMedicareState Childr enrsquosHealthInsuranceProgram(SCHIP))andprivateheal thinsurers

Reimbursableincertainorganizationssuchasfederallyqualifiedhealthcentersand communityhealthcent ers

Reimbursabletopublichealthandtocommunity‐basedo rganizations Reimbursableonlevelsthatarecommensuratewithcostoflivingbasedonlocation

Another resourceisthe Community Health Workers Evidence‐Based Models ToolboxpreparedbytheOfficeofRuralHealthPolicyHealthResourcesand ServicesAdministrationUSDepartmentofHealthandHumanServices

6 How can health departments assist with the promotion and use of CHWsSeveralopportunities exist forpublichealthdepartments topromotetheuseof CHWs

Suggestevidence‐basedprevention‐relatedinter ventionsthatexpandaccessuseandqualityofprevent iveservicesb yusingCHWs

PartnerwithstateMed icaidagenciesande ncouragecoverageofevid ence‐based servicesprovidedbyCHWs

Supportoutreachtodisadvantagedcommunitiesorhard‐to‐reach communities ProvideexamplesofeffectivedeliverymodelsthatuseCHWstodeliverservices f orpeoplewithhigh‐burdenchronicconditionssuchasCVDdiabet esandasthma

Providehealthcareproviderswithi nformationaboutinno vative ande vidence‐basedservices(eginterventionsthatengag eCHWsinCVDprevention)

Learnmorebyreading Improving Cancer Prevention and Control How State Health Agencies Can Support Patient Navigators and Community Health Work

7 What policy developments are forthcoming that address access to healthier lifestyle choices

11

Affordable CareAct(ACA)focuses onpreventionand wellnessandsupportshealthylifestylechoicesthroughwellnessprogramsWellnessprogramsmdashsuchassmokingcessationservicesandweight lossservicesmdasharedesignedtohelppeopleimprovetheir lifestylesByconcentratingonthecausesofchronicdisease ACAchangesthe nationrsquosapproachfroma focusonsicknessanddiseaseto oneof wellnessandprevention

Training 1 Are there any efforts being made toward creating a standardized national curriculum and certification

programOnenationaleffortthatmaybeof interestisthe CHWCore Consensus(C3)ProjectThiseffortiscoordinatedbytheUniversityofTex asSchoolofPublicHealthInstituteforHealthC3isadministeredbyTheNationalAreaHealthEducationCentersOrganizationa ndf undedbyTheAmgenFoundationandsupplementalcontract andin‐kindcontributionsTheprojectaimistoofferCHWandothers takeholder‐drivenldquocontemporaryrdquo recommendationsforconsiderationandadoptionthroughouttheUnitedStatesrel atedtoC HWcoreroles(scopeofpractice)CHW coreskillsandaffirmexistingknowledgeaboutCHWcorequalitiesArev iewofCHWC3 projectgroupfindingsi sunderway andthegoalistogetfeedb ackon ande ndorsementby CHWnetworkleadersof C3projectrecommendedroless killsandaffirmationofq ualities

2 Are there any strategies for training and learning experience of the CHWs

CHWsshouldhavethetrainingrequiredbythelawsineffectin the state in orderto bereimbursedfortheirserviceSomestat esrequirecertification fortheCHWtobereimbursablefortheirservicesEntitieslikeArea HealthEducation Cen ters (AHECs)communitycollegesandothersp rovidecoreCHWtrainingOn‐the‐jobtrainingmaybeprovidedo nthebasisofthe diseaseconditionaddressedAg oodsummary oflessonslearnedin t rainingpracticescanbe foundatthe UniversityofArizonarsquosCHWNationalEducation Collaborativ e website

Paymentforservicesis critical for a sustainable role for CHWsPaymentbyavarietyof sourcesincludingMedicaidMedicaidManagedCareOrganizationsandinclusionamong thepaidworkforce byhospitalsareallviablewaysof ensuringsustainablepayment7A nationwidestatusonCHWsTrainingorcertificationstandardsaswellasreimbursementmechanismisavailableby the ASTHO

3 Sustainability of CHWs certificates is training national or state by stateThereisno natio nallyadoptedcurriculumfortrainingofCHWs Severalcurriculaarebeingusedandimplementedbyvariousentitiesincludingcommunityco llegesuniversitiesandothers

4 What skills should we look for knowing that most training will be on the jobTheskillsrequiredwilldifferbyst ateandwill belistedinthecert ificationstandardsforthestateFindinforma tion aboutwhichstateshavecertificationstandardsat the CommunityHealth Worker(CHWs)TrainingorCertificationStandards

12

Itiswidely recognized thatpracticalon‐the‐jobtraining for CHWshasequalorgreatervalue comparedwithclassroomlearning TheUSDepartmentofLaborhasrecognizedCHWsasaldquoskilledtraderdquoPilotCHWapprenticeshipprogramshavebeenstartedinTexasMassachusettsandWisconsin(and likelyinotherstates) For contactsinspecific statespleasewritetoCarlRushattheUniversityofTexasInstitutefor HealthPolicycarlhrushuthtmcedu

5 Where or how can CHWs obtain inexpensive training on how to manage or prevent chronic illnessesTrainingavailabilitycontent and costvariesfromstatetostateAreaHealthEducationCenters and community collegesofferCHWtrainings invariousstates

CHWslevelofpractice fordiabetes education islevel1

1Pleaseseedetailsfor levels of practice for diabetes educators for CHWs at AADErsquos ldquoDiabetes Educator Practice Levelsrdquo documentandthecourseAADEoffers Diabetes Paraprofessional Level1

6 The ADA encourages our interns to become certified CHWs Where can they get certifiedThisdependsonthetrainingand certificationarrangements in your stateLearnmoreabout thestatusontrainingandcertificationoptionsinstatesatthe CHWs Training or Certification Standards websiteLearnmoreaboutavailabletrainingto deliveror supportDSMEprogramsat AADErsquosEducationand Careerwebsite

Acknowledgements

ManyNCCDPHPCommunityHealthWorker(CHW)WorkgroupmemberscontributedtothedevelopmentofthisdocumentA corewritingandreviewteam helpedresearchwrite andrefine contentdraftsTheirdedication and assistance wereinvaluable

Betsy Rodriacuteguez MSN CDE Deputy Director National Diabetes Education Program

Caitlin G Allen MPH CHES Community‐Clinical Linkages Applied Researcher Division of Heart Disease and Stroke Prevention

Bina Jayapaul‐Philip PhD Health Scientist Division of Diabetes Translation

Melanie Carmel Lagarde RN MPH CHES Office of Health System Collaboration Office of the Associate Director for Policy Office of the Director

Elizabeth A Rohan PhD MSW Health Scientist Division of Cancer Prevention and Control

David Ojeda MS Contractor National Diabetes Education Program

Refilwe Moeti MA Public Health Educator Division for Heart Disease and Stroke Prevention

13

byusingCHWsForexamplecost‐effectiveness ofnursepractitioner andCHWteamsis discussedinthisarticlemdashldquoCost‐Effectivenessof NursePractitionerCommunityHealthWorkerCaretoReduceCardiovascularHealthDisparitiesrdquo J Cardiovasc Nurs Resourcesthatprovidemoreinformationinclude Update onPreventiveServices Initiatives and Medicaid Preventive Services Regulatory Change

Moredetail isavailable inthe articleldquoClinicalPreventiveServicesCoverageand theAffordable Care Actrdquo

Trustfor AmericarsquosHealthhasa policywebsitewithlinks to position statements andletters on varioustopics

FinancingandSustainability 1 How are CHWs compensated for their servicesTheNationalAcademyforStateHealthPolicyhasa StateCHWModelswebsite thatincludes sourcesofCHWfinancingbystate

Learnmoreat Medicaid Funding of Community‐Based Prevention Myths State Successes Overcoming Barriers and the Promise of Integrated Payment Models Prepared by Nemours

2 What is the official job code for CHWs Where can I find information on CHW wages and organizations that employ themTheDepartmentofLaborrecognizedCHWjobsasadistinctcategoryofemployment in2009TheStandardOccupationalClassificationcode forCHWsis 21‐1094(see BureauofLabor Statistics)

There are no thoroughnationalstudieson CHWwagesTheHealth ResourcesandServicesAdministration(HRSA)conducted anationalworkforcestudyin2007called Community Health Worker National Workforce Study butthisstudywasnotacomprehensiveassessmentandthe information isconsideredoutdated

There are variations in CHWwages basedonlocation(eg differences onthebasis oflocalcostoflivingconsiderations)InadditionactualCHWpositionsvaryinthelevelofskillrequiredNotallpositionsrequirethefullrangeof CHWcapabilities Forexamplethere aremanyldquooutreachworkerrdquojobsthataretypicallypaid less($1000‐$1200perhour)thanthoseworkingwithinhealth caremdashinsomecasesasmembersofpatient careteamswheretheymaybepaid$1500‐$2500 perhour

There areseverallocalstate andregionalstudiesthatincludecompensation‐relatedquestionsFindingsfrom onestudycanbefoundat Community Health Workers in the Midwest Understanding and Developing the Workforce

Itisnot knownwhetherthere are anystates withCHWcompensationpoliciesbesidesstategovernmentinternalhumanresourcessystemsSpecificstate‐fundedprogramssuchasMedicaidmayhaveestablished CHWwages7

9

3 How are CHW‐related interventions included in funded national prevention programsCDCrsquosNationalAsthma ControlProgram(NACP)fundsstatesandotherpartners toprovidetrainingeducationand surveillanceprogramsTheMassachusettsAsthmaPreventionandControlProgramworksonefforts tosustain asthmaclinicalcarethroughactivitiesaimedatincreasingthevoluntarycoveragebyinsurerssuchashomevisitsbyCHWsSeveralMassachusettsinsurers coverCHW in‐homeasthmaeducationand assessment Therearevariousresourcesdevelopedby NACP

CDCfunds otherchronicdiseaseprogramsinvolvingCHWsthrough cooperativeagreements Forasummaryof eachprogramvisit Addressing Chronic Disease Through Community Health Workers A Policy and Systems Approach

4 What are the recommendations for increasing the use of CHWsOfparticularimportance isthereco mmendationestablishedbytheCommunityPreventiveServicesTaskForceregardingevidencetosupporttheengagementofCHWsin a team‐basedcaremodeltopreventCVDFurtherevidencesupportstheirengagementtoimprovebloodpressureandcholesterolinpatientsatincreasedriskf orC VD ThedocumentCardiovascular Disease Prevention and Control Interventions Engaging Community Health Workers

Otherusefuldocumentsinclude

MillionHeartsfact sheet insupportofusingCHWs Addressing Chronic Disease Through CHWs A Policy and Systems‐Level Approachdeveloped byCDCrsquosNational Centerfor ChronicDisease PreventionandHealthPromotion Divisionfor HeartDiseaseandStrokePreventionprovidesguidanceandresourcesforimplementingrecommendationstouseCHWstoaddresschronichigh‐burdendiseasessuchasdiabetes andasthma

Optimizing Health Outcomes for Children with Asthma in DelawaredevelopedbyNemoursChildrenrsquosHealthSystemNemoursHealthamp Prevention ServicesThedocumenthighlightstheNemoursrsquo Optimizing HealthOutcomes(OHO)forChildren withAsthmainDelawareproject fundedbytheCentersfor Medicare amp Medicaidrsquos Innovation Center(CMMI)theInnovation CenterrsquosHealth CareInnovation Awards(HCIA)TheOHOprojecthighlightsinterdisciplinaryteam‐basedapproachestocareNinefull‐timeCHWseither inproviderpracticesortheNemoursAlfredIduPontHospitalfor Children inWilmingtonDelaware

ldquoCost‐Effectivenessof NursePractitionerCommunityHealthWorkerCare toReduceCardiovascular HealthDisparitiesrdquoIsanarticlethathighlightsthecost‐effectivenessofnursepractitionerorCHWteamstoreduceCVD disparitiesmdash

5 How do I address sustainability of the CHW workforceStayabreastofstatepolicyactions TheNationalAcademyfor StateHealthPolicy (NASHP) websiteisa nexcellentr esourceandfeaturesawealthofinfor mationconcerningCHWTheldquoStateC HWLegislationrdquotabcontainslinkstospecificbills andbillhistoriesa ndactionsby

10

stateAlaskaasan examplehasstatutesrelatedtoldquocommunityhealthaiderdquograntsMinnesotalawallowsCHWstoparticipatein Medicaidprogramsandreceive paymentforservices

TheASTHO StateHealth PolicyTeamtracksstatelawconcerning CHWcertificationstandardsTheStateofIllinoisfor exampleenactedalaw thatprovides certification standardsforCHWs Achartoutliningthesummariesof eachstatersquos CHWcertificationbillisalsoavailableLearn moreattheASTHO CHWresourcessite

StayabreastofCHWtrainingstandardsandcorecompetenciesTrainingcapacitybuildingpolicyandintegration resourcesaredetailedin Addressing Chronic Disease through Community Health Workers A Policy and Systems‐Level ApproachdevelopedbyCDCrsquosNationalCenter forChronicDiseasePreventionandHealthPromotionDivision forHeartDiseaseandStrokePreventionFinancingmechanismsforsustainableemploymentarealsooutlinedinthisdocument CHWservices are

Reimbursablebypublicpayers(egMedicaidMedicareState Childr enrsquosHealthInsuranceProgram(SCHIP))andprivateheal thinsurers

Reimbursableincertainorganizationssuchasfederallyqualifiedhealthcentersand communityhealthcent ers

Reimbursabletopublichealthandtocommunity‐basedo rganizations Reimbursableonlevelsthatarecommensuratewithcostoflivingbasedonlocation

Another resourceisthe Community Health Workers Evidence‐Based Models ToolboxpreparedbytheOfficeofRuralHealthPolicyHealthResourcesand ServicesAdministrationUSDepartmentofHealthandHumanServices

6 How can health departments assist with the promotion and use of CHWsSeveralopportunities exist forpublichealthdepartments topromotetheuseof CHWs

Suggestevidence‐basedprevention‐relatedinter ventionsthatexpandaccessuseandqualityofprevent iveservicesb yusingCHWs

PartnerwithstateMed icaidagenciesande ncouragecoverageofevid ence‐based servicesprovidedbyCHWs

Supportoutreachtodisadvantagedcommunitiesorhard‐to‐reach communities ProvideexamplesofeffectivedeliverymodelsthatuseCHWstodeliverservices f orpeoplewithhigh‐burdenchronicconditionssuchasCVDdiabet esandasthma

Providehealthcareproviderswithi nformationaboutinno vative ande vidence‐basedservices(eginterventionsthatengag eCHWsinCVDprevention)

Learnmorebyreading Improving Cancer Prevention and Control How State Health Agencies Can Support Patient Navigators and Community Health Work

7 What policy developments are forthcoming that address access to healthier lifestyle choices

11

Affordable CareAct(ACA)focuses onpreventionand wellnessandsupportshealthylifestylechoicesthroughwellnessprogramsWellnessprogramsmdashsuchassmokingcessationservicesandweight lossservicesmdasharedesignedtohelppeopleimprovetheir lifestylesByconcentratingonthecausesofchronicdisease ACAchangesthe nationrsquosapproachfroma focusonsicknessanddiseaseto oneof wellnessandprevention

Training 1 Are there any efforts being made toward creating a standardized national curriculum and certification

programOnenationaleffortthatmaybeof interestisthe CHWCore Consensus(C3)ProjectThiseffortiscoordinatedbytheUniversityofTex asSchoolofPublicHealthInstituteforHealthC3isadministeredbyTheNationalAreaHealthEducationCentersOrganizationa ndf undedbyTheAmgenFoundationandsupplementalcontract andin‐kindcontributionsTheprojectaimistoofferCHWandothers takeholder‐drivenldquocontemporaryrdquo recommendationsforconsiderationandadoptionthroughouttheUnitedStatesrel atedtoC HWcoreroles(scopeofpractice)CHW coreskillsandaffirmexistingknowledgeaboutCHWcorequalitiesArev iewofCHWC3 projectgroupfindingsi sunderway andthegoalistogetfeedb ackon ande ndorsementby CHWnetworkleadersof C3projectrecommendedroless killsandaffirmationofq ualities

2 Are there any strategies for training and learning experience of the CHWs

CHWsshouldhavethetrainingrequiredbythelawsineffectin the state in orderto bereimbursedfortheirserviceSomestat esrequirecertification fortheCHWtobereimbursablefortheirservicesEntitieslikeArea HealthEducation Cen ters (AHECs)communitycollegesandothersp rovidecoreCHWtrainingOn‐the‐jobtrainingmaybeprovidedo nthebasisofthe diseaseconditionaddressedAg oodsummary oflessonslearnedin t rainingpracticescanbe foundatthe UniversityofArizonarsquosCHWNationalEducation Collaborativ e website

Paymentforservicesis critical for a sustainable role for CHWsPaymentbyavarietyof sourcesincludingMedicaidMedicaidManagedCareOrganizationsandinclusionamong thepaidworkforce byhospitalsareallviablewaysof ensuringsustainablepayment7A nationwidestatusonCHWsTrainingorcertificationstandardsaswellasreimbursementmechanismisavailableby the ASTHO

3 Sustainability of CHWs certificates is training national or state by stateThereisno natio nallyadoptedcurriculumfortrainingofCHWs Severalcurriculaarebeingusedandimplementedbyvariousentitiesincludingcommunityco llegesuniversitiesandothers

4 What skills should we look for knowing that most training will be on the jobTheskillsrequiredwilldifferbyst ateandwill belistedinthecert ificationstandardsforthestateFindinforma tion aboutwhichstateshavecertificationstandardsat the CommunityHealth Worker(CHWs)TrainingorCertificationStandards

12

Itiswidely recognized thatpracticalon‐the‐jobtraining for CHWshasequalorgreatervalue comparedwithclassroomlearning TheUSDepartmentofLaborhasrecognizedCHWsasaldquoskilledtraderdquoPilotCHWapprenticeshipprogramshavebeenstartedinTexasMassachusettsandWisconsin(and likelyinotherstates) For contactsinspecific statespleasewritetoCarlRushattheUniversityofTexasInstitutefor HealthPolicycarlhrushuthtmcedu

5 Where or how can CHWs obtain inexpensive training on how to manage or prevent chronic illnessesTrainingavailabilitycontent and costvariesfromstatetostateAreaHealthEducationCenters and community collegesofferCHWtrainings invariousstates

CHWslevelofpractice fordiabetes education islevel1

1Pleaseseedetailsfor levels of practice for diabetes educators for CHWs at AADErsquos ldquoDiabetes Educator Practice Levelsrdquo documentandthecourseAADEoffers Diabetes Paraprofessional Level1

6 The ADA encourages our interns to become certified CHWs Where can they get certifiedThisdependsonthetrainingand certificationarrangements in your stateLearnmoreabout thestatusontrainingandcertificationoptionsinstatesatthe CHWs Training or Certification Standards websiteLearnmoreaboutavailabletrainingto deliveror supportDSMEprogramsat AADErsquosEducationand Careerwebsite

Acknowledgements

ManyNCCDPHPCommunityHealthWorker(CHW)WorkgroupmemberscontributedtothedevelopmentofthisdocumentA corewritingandreviewteam helpedresearchwrite andrefine contentdraftsTheirdedication and assistance wereinvaluable

Betsy Rodriacuteguez MSN CDE Deputy Director National Diabetes Education Program

Caitlin G Allen MPH CHES Community‐Clinical Linkages Applied Researcher Division of Heart Disease and Stroke Prevention

Bina Jayapaul‐Philip PhD Health Scientist Division of Diabetes Translation

Melanie Carmel Lagarde RN MPH CHES Office of Health System Collaboration Office of the Associate Director for Policy Office of the Director

Elizabeth A Rohan PhD MSW Health Scientist Division of Cancer Prevention and Control

David Ojeda MS Contractor National Diabetes Education Program

Refilwe Moeti MA Public Health Educator Division for Heart Disease and Stroke Prevention

13

3 How are CHW‐related interventions included in funded national prevention programsCDCrsquosNationalAsthma ControlProgram(NACP)fundsstatesandotherpartners toprovidetrainingeducationand surveillanceprogramsTheMassachusettsAsthmaPreventionandControlProgramworksonefforts tosustain asthmaclinicalcarethroughactivitiesaimedatincreasingthevoluntarycoveragebyinsurerssuchashomevisitsbyCHWsSeveralMassachusettsinsurers coverCHW in‐homeasthmaeducationand assessment Therearevariousresourcesdevelopedby NACP

CDCfunds otherchronicdiseaseprogramsinvolvingCHWsthrough cooperativeagreements Forasummaryof eachprogramvisit Addressing Chronic Disease Through Community Health Workers A Policy and Systems Approach

4 What are the recommendations for increasing the use of CHWsOfparticularimportance isthereco mmendationestablishedbytheCommunityPreventiveServicesTaskForceregardingevidencetosupporttheengagementofCHWsin a team‐basedcaremodeltopreventCVDFurtherevidencesupportstheirengagementtoimprovebloodpressureandcholesterolinpatientsatincreasedriskf orC VD ThedocumentCardiovascular Disease Prevention and Control Interventions Engaging Community Health Workers

Otherusefuldocumentsinclude

MillionHeartsfact sheet insupportofusingCHWs Addressing Chronic Disease Through CHWs A Policy and Systems‐Level Approachdeveloped byCDCrsquosNational Centerfor ChronicDisease PreventionandHealthPromotion Divisionfor HeartDiseaseandStrokePreventionprovidesguidanceandresourcesforimplementingrecommendationstouseCHWstoaddresschronichigh‐burdendiseasessuchasdiabetes andasthma

Optimizing Health Outcomes for Children with Asthma in DelawaredevelopedbyNemoursChildrenrsquosHealthSystemNemoursHealthamp Prevention ServicesThedocumenthighlightstheNemoursrsquo Optimizing HealthOutcomes(OHO)forChildren withAsthmainDelawareproject fundedbytheCentersfor Medicare amp Medicaidrsquos Innovation Center(CMMI)theInnovation CenterrsquosHealth CareInnovation Awards(HCIA)TheOHOprojecthighlightsinterdisciplinaryteam‐basedapproachestocareNinefull‐timeCHWseither inproviderpracticesortheNemoursAlfredIduPontHospitalfor Children inWilmingtonDelaware

ldquoCost‐Effectivenessof NursePractitionerCommunityHealthWorkerCare toReduceCardiovascular HealthDisparitiesrdquoIsanarticlethathighlightsthecost‐effectivenessofnursepractitionerorCHWteamstoreduceCVD disparitiesmdash

5 How do I address sustainability of the CHW workforceStayabreastofstatepolicyactions TheNationalAcademyfor StateHealthPolicy (NASHP) websiteisa nexcellentr esourceandfeaturesawealthofinfor mationconcerningCHWTheldquoStateC HWLegislationrdquotabcontainslinkstospecificbills andbillhistoriesa ndactionsby

10

stateAlaskaasan examplehasstatutesrelatedtoldquocommunityhealthaiderdquograntsMinnesotalawallowsCHWstoparticipatein Medicaidprogramsandreceive paymentforservices

TheASTHO StateHealth PolicyTeamtracksstatelawconcerning CHWcertificationstandardsTheStateofIllinoisfor exampleenactedalaw thatprovides certification standardsforCHWs Achartoutliningthesummariesof eachstatersquos CHWcertificationbillisalsoavailableLearn moreattheASTHO CHWresourcessite

StayabreastofCHWtrainingstandardsandcorecompetenciesTrainingcapacitybuildingpolicyandintegration resourcesaredetailedin Addressing Chronic Disease through Community Health Workers A Policy and Systems‐Level ApproachdevelopedbyCDCrsquosNationalCenter forChronicDiseasePreventionandHealthPromotionDivision forHeartDiseaseandStrokePreventionFinancingmechanismsforsustainableemploymentarealsooutlinedinthisdocument CHWservices are

Reimbursablebypublicpayers(egMedicaidMedicareState Childr enrsquosHealthInsuranceProgram(SCHIP))andprivateheal thinsurers

Reimbursableincertainorganizationssuchasfederallyqualifiedhealthcentersand communityhealthcent ers

Reimbursabletopublichealthandtocommunity‐basedo rganizations Reimbursableonlevelsthatarecommensuratewithcostoflivingbasedonlocation

Another resourceisthe Community Health Workers Evidence‐Based Models ToolboxpreparedbytheOfficeofRuralHealthPolicyHealthResourcesand ServicesAdministrationUSDepartmentofHealthandHumanServices

6 How can health departments assist with the promotion and use of CHWsSeveralopportunities exist forpublichealthdepartments topromotetheuseof CHWs

Suggestevidence‐basedprevention‐relatedinter ventionsthatexpandaccessuseandqualityofprevent iveservicesb yusingCHWs

PartnerwithstateMed icaidagenciesande ncouragecoverageofevid ence‐based servicesprovidedbyCHWs

Supportoutreachtodisadvantagedcommunitiesorhard‐to‐reach communities ProvideexamplesofeffectivedeliverymodelsthatuseCHWstodeliverservices f orpeoplewithhigh‐burdenchronicconditionssuchasCVDdiabet esandasthma

Providehealthcareproviderswithi nformationaboutinno vative ande vidence‐basedservices(eginterventionsthatengag eCHWsinCVDprevention)

Learnmorebyreading Improving Cancer Prevention and Control How State Health Agencies Can Support Patient Navigators and Community Health Work

7 What policy developments are forthcoming that address access to healthier lifestyle choices

11

Affordable CareAct(ACA)focuses onpreventionand wellnessandsupportshealthylifestylechoicesthroughwellnessprogramsWellnessprogramsmdashsuchassmokingcessationservicesandweight lossservicesmdasharedesignedtohelppeopleimprovetheir lifestylesByconcentratingonthecausesofchronicdisease ACAchangesthe nationrsquosapproachfroma focusonsicknessanddiseaseto oneof wellnessandprevention

Training 1 Are there any efforts being made toward creating a standardized national curriculum and certification

programOnenationaleffortthatmaybeof interestisthe CHWCore Consensus(C3)ProjectThiseffortiscoordinatedbytheUniversityofTex asSchoolofPublicHealthInstituteforHealthC3isadministeredbyTheNationalAreaHealthEducationCentersOrganizationa ndf undedbyTheAmgenFoundationandsupplementalcontract andin‐kindcontributionsTheprojectaimistoofferCHWandothers takeholder‐drivenldquocontemporaryrdquo recommendationsforconsiderationandadoptionthroughouttheUnitedStatesrel atedtoC HWcoreroles(scopeofpractice)CHW coreskillsandaffirmexistingknowledgeaboutCHWcorequalitiesArev iewofCHWC3 projectgroupfindingsi sunderway andthegoalistogetfeedb ackon ande ndorsementby CHWnetworkleadersof C3projectrecommendedroless killsandaffirmationofq ualities

2 Are there any strategies for training and learning experience of the CHWs

CHWsshouldhavethetrainingrequiredbythelawsineffectin the state in orderto bereimbursedfortheirserviceSomestat esrequirecertification fortheCHWtobereimbursablefortheirservicesEntitieslikeArea HealthEducation Cen ters (AHECs)communitycollegesandothersp rovidecoreCHWtrainingOn‐the‐jobtrainingmaybeprovidedo nthebasisofthe diseaseconditionaddressedAg oodsummary oflessonslearnedin t rainingpracticescanbe foundatthe UniversityofArizonarsquosCHWNationalEducation Collaborativ e website

Paymentforservicesis critical for a sustainable role for CHWsPaymentbyavarietyof sourcesincludingMedicaidMedicaidManagedCareOrganizationsandinclusionamong thepaidworkforce byhospitalsareallviablewaysof ensuringsustainablepayment7A nationwidestatusonCHWsTrainingorcertificationstandardsaswellasreimbursementmechanismisavailableby the ASTHO

3 Sustainability of CHWs certificates is training national or state by stateThereisno natio nallyadoptedcurriculumfortrainingofCHWs Severalcurriculaarebeingusedandimplementedbyvariousentitiesincludingcommunityco llegesuniversitiesandothers

4 What skills should we look for knowing that most training will be on the jobTheskillsrequiredwilldifferbyst ateandwill belistedinthecert ificationstandardsforthestateFindinforma tion aboutwhichstateshavecertificationstandardsat the CommunityHealth Worker(CHWs)TrainingorCertificationStandards

12

Itiswidely recognized thatpracticalon‐the‐jobtraining for CHWshasequalorgreatervalue comparedwithclassroomlearning TheUSDepartmentofLaborhasrecognizedCHWsasaldquoskilledtraderdquoPilotCHWapprenticeshipprogramshavebeenstartedinTexasMassachusettsandWisconsin(and likelyinotherstates) For contactsinspecific statespleasewritetoCarlRushattheUniversityofTexasInstitutefor HealthPolicycarlhrushuthtmcedu

5 Where or how can CHWs obtain inexpensive training on how to manage or prevent chronic illnessesTrainingavailabilitycontent and costvariesfromstatetostateAreaHealthEducationCenters and community collegesofferCHWtrainings invariousstates

CHWslevelofpractice fordiabetes education islevel1

1Pleaseseedetailsfor levels of practice for diabetes educators for CHWs at AADErsquos ldquoDiabetes Educator Practice Levelsrdquo documentandthecourseAADEoffers Diabetes Paraprofessional Level1

6 The ADA encourages our interns to become certified CHWs Where can they get certifiedThisdependsonthetrainingand certificationarrangements in your stateLearnmoreabout thestatusontrainingandcertificationoptionsinstatesatthe CHWs Training or Certification Standards websiteLearnmoreaboutavailabletrainingto deliveror supportDSMEprogramsat AADErsquosEducationand Careerwebsite

Acknowledgements

ManyNCCDPHPCommunityHealthWorker(CHW)WorkgroupmemberscontributedtothedevelopmentofthisdocumentA corewritingandreviewteam helpedresearchwrite andrefine contentdraftsTheirdedication and assistance wereinvaluable

Betsy Rodriacuteguez MSN CDE Deputy Director National Diabetes Education Program

Caitlin G Allen MPH CHES Community‐Clinical Linkages Applied Researcher Division of Heart Disease and Stroke Prevention

Bina Jayapaul‐Philip PhD Health Scientist Division of Diabetes Translation

Melanie Carmel Lagarde RN MPH CHES Office of Health System Collaboration Office of the Associate Director for Policy Office of the Director

Elizabeth A Rohan PhD MSW Health Scientist Division of Cancer Prevention and Control

David Ojeda MS Contractor National Diabetes Education Program

Refilwe Moeti MA Public Health Educator Division for Heart Disease and Stroke Prevention

13

stateAlaskaasan examplehasstatutesrelatedtoldquocommunityhealthaiderdquograntsMinnesotalawallowsCHWstoparticipatein Medicaidprogramsandreceive paymentforservices

TheASTHO StateHealth PolicyTeamtracksstatelawconcerning CHWcertificationstandardsTheStateofIllinoisfor exampleenactedalaw thatprovides certification standardsforCHWs Achartoutliningthesummariesof eachstatersquos CHWcertificationbillisalsoavailableLearn moreattheASTHO CHWresourcessite

StayabreastofCHWtrainingstandardsandcorecompetenciesTrainingcapacitybuildingpolicyandintegration resourcesaredetailedin Addressing Chronic Disease through Community Health Workers A Policy and Systems‐Level ApproachdevelopedbyCDCrsquosNationalCenter forChronicDiseasePreventionandHealthPromotionDivision forHeartDiseaseandStrokePreventionFinancingmechanismsforsustainableemploymentarealsooutlinedinthisdocument CHWservices are

Reimbursablebypublicpayers(egMedicaidMedicareState Childr enrsquosHealthInsuranceProgram(SCHIP))andprivateheal thinsurers

Reimbursableincertainorganizationssuchasfederallyqualifiedhealthcentersand communityhealthcent ers

Reimbursabletopublichealthandtocommunity‐basedo rganizations Reimbursableonlevelsthatarecommensuratewithcostoflivingbasedonlocation

Another resourceisthe Community Health Workers Evidence‐Based Models ToolboxpreparedbytheOfficeofRuralHealthPolicyHealthResourcesand ServicesAdministrationUSDepartmentofHealthandHumanServices

6 How can health departments assist with the promotion and use of CHWsSeveralopportunities exist forpublichealthdepartments topromotetheuseof CHWs

Suggestevidence‐basedprevention‐relatedinter ventionsthatexpandaccessuseandqualityofprevent iveservicesb yusingCHWs

PartnerwithstateMed icaidagenciesande ncouragecoverageofevid ence‐based servicesprovidedbyCHWs

Supportoutreachtodisadvantagedcommunitiesorhard‐to‐reach communities ProvideexamplesofeffectivedeliverymodelsthatuseCHWstodeliverservices f orpeoplewithhigh‐burdenchronicconditionssuchasCVDdiabet esandasthma

Providehealthcareproviderswithi nformationaboutinno vative ande vidence‐basedservices(eginterventionsthatengag eCHWsinCVDprevention)

Learnmorebyreading Improving Cancer Prevention and Control How State Health Agencies Can Support Patient Navigators and Community Health Work

7 What policy developments are forthcoming that address access to healthier lifestyle choices

11

Affordable CareAct(ACA)focuses onpreventionand wellnessandsupportshealthylifestylechoicesthroughwellnessprogramsWellnessprogramsmdashsuchassmokingcessationservicesandweight lossservicesmdasharedesignedtohelppeopleimprovetheir lifestylesByconcentratingonthecausesofchronicdisease ACAchangesthe nationrsquosapproachfroma focusonsicknessanddiseaseto oneof wellnessandprevention

Training 1 Are there any efforts being made toward creating a standardized national curriculum and certification

programOnenationaleffortthatmaybeof interestisthe CHWCore Consensus(C3)ProjectThiseffortiscoordinatedbytheUniversityofTex asSchoolofPublicHealthInstituteforHealthC3isadministeredbyTheNationalAreaHealthEducationCentersOrganizationa ndf undedbyTheAmgenFoundationandsupplementalcontract andin‐kindcontributionsTheprojectaimistoofferCHWandothers takeholder‐drivenldquocontemporaryrdquo recommendationsforconsiderationandadoptionthroughouttheUnitedStatesrel atedtoC HWcoreroles(scopeofpractice)CHW coreskillsandaffirmexistingknowledgeaboutCHWcorequalitiesArev iewofCHWC3 projectgroupfindingsi sunderway andthegoalistogetfeedb ackon ande ndorsementby CHWnetworkleadersof C3projectrecommendedroless killsandaffirmationofq ualities

2 Are there any strategies for training and learning experience of the CHWs

CHWsshouldhavethetrainingrequiredbythelawsineffectin the state in orderto bereimbursedfortheirserviceSomestat esrequirecertification fortheCHWtobereimbursablefortheirservicesEntitieslikeArea HealthEducation Cen ters (AHECs)communitycollegesandothersp rovidecoreCHWtrainingOn‐the‐jobtrainingmaybeprovidedo nthebasisofthe diseaseconditionaddressedAg oodsummary oflessonslearnedin t rainingpracticescanbe foundatthe UniversityofArizonarsquosCHWNationalEducation Collaborativ e website

Paymentforservicesis critical for a sustainable role for CHWsPaymentbyavarietyof sourcesincludingMedicaidMedicaidManagedCareOrganizationsandinclusionamong thepaidworkforce byhospitalsareallviablewaysof ensuringsustainablepayment7A nationwidestatusonCHWsTrainingorcertificationstandardsaswellasreimbursementmechanismisavailableby the ASTHO

3 Sustainability of CHWs certificates is training national or state by stateThereisno natio nallyadoptedcurriculumfortrainingofCHWs Severalcurriculaarebeingusedandimplementedbyvariousentitiesincludingcommunityco llegesuniversitiesandothers

4 What skills should we look for knowing that most training will be on the jobTheskillsrequiredwilldifferbyst ateandwill belistedinthecert ificationstandardsforthestateFindinforma tion aboutwhichstateshavecertificationstandardsat the CommunityHealth Worker(CHWs)TrainingorCertificationStandards

12

Itiswidely recognized thatpracticalon‐the‐jobtraining for CHWshasequalorgreatervalue comparedwithclassroomlearning TheUSDepartmentofLaborhasrecognizedCHWsasaldquoskilledtraderdquoPilotCHWapprenticeshipprogramshavebeenstartedinTexasMassachusettsandWisconsin(and likelyinotherstates) For contactsinspecific statespleasewritetoCarlRushattheUniversityofTexasInstitutefor HealthPolicycarlhrushuthtmcedu

5 Where or how can CHWs obtain inexpensive training on how to manage or prevent chronic illnessesTrainingavailabilitycontent and costvariesfromstatetostateAreaHealthEducationCenters and community collegesofferCHWtrainings invariousstates

CHWslevelofpractice fordiabetes education islevel1

1Pleaseseedetailsfor levels of practice for diabetes educators for CHWs at AADErsquos ldquoDiabetes Educator Practice Levelsrdquo documentandthecourseAADEoffers Diabetes Paraprofessional Level1

6 The ADA encourages our interns to become certified CHWs Where can they get certifiedThisdependsonthetrainingand certificationarrangements in your stateLearnmoreabout thestatusontrainingandcertificationoptionsinstatesatthe CHWs Training or Certification Standards websiteLearnmoreaboutavailabletrainingto deliveror supportDSMEprogramsat AADErsquosEducationand Careerwebsite

Acknowledgements

ManyNCCDPHPCommunityHealthWorker(CHW)WorkgroupmemberscontributedtothedevelopmentofthisdocumentA corewritingandreviewteam helpedresearchwrite andrefine contentdraftsTheirdedication and assistance wereinvaluable

Betsy Rodriacuteguez MSN CDE Deputy Director National Diabetes Education Program

Caitlin G Allen MPH CHES Community‐Clinical Linkages Applied Researcher Division of Heart Disease and Stroke Prevention

Bina Jayapaul‐Philip PhD Health Scientist Division of Diabetes Translation

Melanie Carmel Lagarde RN MPH CHES Office of Health System Collaboration Office of the Associate Director for Policy Office of the Director

Elizabeth A Rohan PhD MSW Health Scientist Division of Cancer Prevention and Control

David Ojeda MS Contractor National Diabetes Education Program

Refilwe Moeti MA Public Health Educator Division for Heart Disease and Stroke Prevention

13

Affordable CareAct(ACA)focuses onpreventionand wellnessandsupportshealthylifestylechoicesthroughwellnessprogramsWellnessprogramsmdashsuchassmokingcessationservicesandweight lossservicesmdasharedesignedtohelppeopleimprovetheir lifestylesByconcentratingonthecausesofchronicdisease ACAchangesthe nationrsquosapproachfroma focusonsicknessanddiseaseto oneof wellnessandprevention

Training 1 Are there any efforts being made toward creating a standardized national curriculum and certification

programOnenationaleffortthatmaybeof interestisthe CHWCore Consensus(C3)ProjectThiseffortiscoordinatedbytheUniversityofTex asSchoolofPublicHealthInstituteforHealthC3isadministeredbyTheNationalAreaHealthEducationCentersOrganizationa ndf undedbyTheAmgenFoundationandsupplementalcontract andin‐kindcontributionsTheprojectaimistoofferCHWandothers takeholder‐drivenldquocontemporaryrdquo recommendationsforconsiderationandadoptionthroughouttheUnitedStatesrel atedtoC HWcoreroles(scopeofpractice)CHW coreskillsandaffirmexistingknowledgeaboutCHWcorequalitiesArev iewofCHWC3 projectgroupfindingsi sunderway andthegoalistogetfeedb ackon ande ndorsementby CHWnetworkleadersof C3projectrecommendedroless killsandaffirmationofq ualities

2 Are there any strategies for training and learning experience of the CHWs

CHWsshouldhavethetrainingrequiredbythelawsineffectin the state in orderto bereimbursedfortheirserviceSomestat esrequirecertification fortheCHWtobereimbursablefortheirservicesEntitieslikeArea HealthEducation Cen ters (AHECs)communitycollegesandothersp rovidecoreCHWtrainingOn‐the‐jobtrainingmaybeprovidedo nthebasisofthe diseaseconditionaddressedAg oodsummary oflessonslearnedin t rainingpracticescanbe foundatthe UniversityofArizonarsquosCHWNationalEducation Collaborativ e website

Paymentforservicesis critical for a sustainable role for CHWsPaymentbyavarietyof sourcesincludingMedicaidMedicaidManagedCareOrganizationsandinclusionamong thepaidworkforce byhospitalsareallviablewaysof ensuringsustainablepayment7A nationwidestatusonCHWsTrainingorcertificationstandardsaswellasreimbursementmechanismisavailableby the ASTHO

3 Sustainability of CHWs certificates is training national or state by stateThereisno natio nallyadoptedcurriculumfortrainingofCHWs Severalcurriculaarebeingusedandimplementedbyvariousentitiesincludingcommunityco llegesuniversitiesandothers

4 What skills should we look for knowing that most training will be on the jobTheskillsrequiredwilldifferbyst ateandwill belistedinthecert ificationstandardsforthestateFindinforma tion aboutwhichstateshavecertificationstandardsat the CommunityHealth Worker(CHWs)TrainingorCertificationStandards

12

Itiswidely recognized thatpracticalon‐the‐jobtraining for CHWshasequalorgreatervalue comparedwithclassroomlearning TheUSDepartmentofLaborhasrecognizedCHWsasaldquoskilledtraderdquoPilotCHWapprenticeshipprogramshavebeenstartedinTexasMassachusettsandWisconsin(and likelyinotherstates) For contactsinspecific statespleasewritetoCarlRushattheUniversityofTexasInstitutefor HealthPolicycarlhrushuthtmcedu

5 Where or how can CHWs obtain inexpensive training on how to manage or prevent chronic illnessesTrainingavailabilitycontent and costvariesfromstatetostateAreaHealthEducationCenters and community collegesofferCHWtrainings invariousstates

CHWslevelofpractice fordiabetes education islevel1

1Pleaseseedetailsfor levels of practice for diabetes educators for CHWs at AADErsquos ldquoDiabetes Educator Practice Levelsrdquo documentandthecourseAADEoffers Diabetes Paraprofessional Level1

6 The ADA encourages our interns to become certified CHWs Where can they get certifiedThisdependsonthetrainingand certificationarrangements in your stateLearnmoreabout thestatusontrainingandcertificationoptionsinstatesatthe CHWs Training or Certification Standards websiteLearnmoreaboutavailabletrainingto deliveror supportDSMEprogramsat AADErsquosEducationand Careerwebsite

Acknowledgements

ManyNCCDPHPCommunityHealthWorker(CHW)WorkgroupmemberscontributedtothedevelopmentofthisdocumentA corewritingandreviewteam helpedresearchwrite andrefine contentdraftsTheirdedication and assistance wereinvaluable

Betsy Rodriacuteguez MSN CDE Deputy Director National Diabetes Education Program

Caitlin G Allen MPH CHES Community‐Clinical Linkages Applied Researcher Division of Heart Disease and Stroke Prevention

Bina Jayapaul‐Philip PhD Health Scientist Division of Diabetes Translation

Melanie Carmel Lagarde RN MPH CHES Office of Health System Collaboration Office of the Associate Director for Policy Office of the Director

Elizabeth A Rohan PhD MSW Health Scientist Division of Cancer Prevention and Control

David Ojeda MS Contractor National Diabetes Education Program

Refilwe Moeti MA Public Health Educator Division for Heart Disease and Stroke Prevention

13

Itiswidely recognized thatpracticalon‐the‐jobtraining for CHWshasequalorgreatervalue comparedwithclassroomlearning TheUSDepartmentofLaborhasrecognizedCHWsasaldquoskilledtraderdquoPilotCHWapprenticeshipprogramshavebeenstartedinTexasMassachusettsandWisconsin(and likelyinotherstates) For contactsinspecific statespleasewritetoCarlRushattheUniversityofTexasInstitutefor HealthPolicycarlhrushuthtmcedu

5 Where or how can CHWs obtain inexpensive training on how to manage or prevent chronic illnessesTrainingavailabilitycontent and costvariesfromstatetostateAreaHealthEducationCenters and community collegesofferCHWtrainings invariousstates

CHWslevelofpractice fordiabetes education islevel1

1Pleaseseedetailsfor levels of practice for diabetes educators for CHWs at AADErsquos ldquoDiabetes Educator Practice Levelsrdquo documentandthecourseAADEoffers Diabetes Paraprofessional Level1

6 The ADA encourages our interns to become certified CHWs Where can they get certifiedThisdependsonthetrainingand certificationarrangements in your stateLearnmoreabout thestatusontrainingandcertificationoptionsinstatesatthe CHWs Training or Certification Standards websiteLearnmoreaboutavailabletrainingto deliveror supportDSMEprogramsat AADErsquosEducationand Careerwebsite

Acknowledgements

ManyNCCDPHPCommunityHealthWorker(CHW)WorkgroupmemberscontributedtothedevelopmentofthisdocumentA corewritingandreviewteam helpedresearchwrite andrefine contentdraftsTheirdedication and assistance wereinvaluable

Betsy Rodriacuteguez MSN CDE Deputy Director National Diabetes Education Program

Caitlin G Allen MPH CHES Community‐Clinical Linkages Applied Researcher Division of Heart Disease and Stroke Prevention

Bina Jayapaul‐Philip PhD Health Scientist Division of Diabetes Translation

Melanie Carmel Lagarde RN MPH CHES Office of Health System Collaboration Office of the Associate Director for Policy Office of the Director

Elizabeth A Rohan PhD MSW Health Scientist Division of Cancer Prevention and Control

David Ojeda MS Contractor National Diabetes Education Program

Refilwe Moeti MA Public Health Educator Division for Heart Disease and Stroke Prevention

13