In healthy communities, everyone has opportunities to thrive. This means being able to access reliable health information in ways that are easy to understand and use. There is scientific evidence demonstrating the value of Community Health Workers (CHWs) in community efforts to reduce health inequities, improve health outcomes, and reduce health care costs.2
Community Health Workers may also be known as community health advocates, lay health advisors, promotoras, community health resources, or peer health educators. What makes CHWs so valuable and unique is that they typically share the culture, language, socioeconomic status, and life experiences with the community members they serve. They are community connectors who are able to serve as mentors, provide culturally appropriate health education and promotion, and navigate the health care system and other services/systems that contribute to health and wellbeing (e.g., education, legal, labor).
The authentic connections that Community Health Workers make create a sense of trust and enable community members to understand and receive health information and services to meet their contexts. The Community Health Worker National Workforce Study conducted by the U.S. Department of Health and Human Services documented several known outcomes of CHW support,3 including:
Due to the evidence4 supporting Community Health Workers’ value, as well as Medicaid rules allowing potential reimbursement for preventive services offered by CHWs, there has been a growing interest in developing training standards and credentialing policies. There are currently few regulations and laws to build and sustain CHW capacity across the country, and they vary by state.
In 2019, Pathways to Health Community Partnership, Inc. and its partners in Oklahoma received Community Collaborative Learning Funds to build a case and capacity for Community Health Worker certification. County Health Rankings & Roadmaps and the Robert Wood Johnson Foundation Culture of Health Prize programs offered the Community Collaborative Learning Funds to help communities to connect with and learn from each other as they work to build a Culture of Health. Healthy Places by Design managed the initiative.
Efforts to grow the capacity and reach of Community Health Workers in Oklahoma were driven by voices of community members who shared: “There is a lack of accurate health information. We get so much info, but don’t know what to believe. We get blindsided by the advertising. (There is no) profit in the real information.” And, “Navigating the system is a challenge. Finding a good doctor and knowing how to make payments are all stressful.”
Although Community Health Workers have been an integral part of local health departments in Oklahoma for years, the state lacks policies or laws for CHW training and certification. As a result, organizations with CHWs are left to develop and seek their own training programs. This means that the quality of services could vary from community to community. Differences in state laws and community contexts also mean that CHW curricula from other states can’t be easily applied.
County Health Rankings & Roadmaps Community Collaborative Learning Funds provided start-up funds to organize, facilitate, and implement training, which organizations and their Community Health Workers were eager and willing to take part in. This support also motivated partners across the state to connect in the training efforts and turn the idea of statewide CHW standards into reality.
In 2019, Pathways to Health, a non-profit entity of the Tulsa Health Department, recognized the need for Community Health Worker training and served as a neutral convener to develop and provide Oklahoma’s first statewide training to prepare for CHW certification. CHWs from Tulsa and Oklahoma Counties, as well as five rural communities across the state, were key partners in the training’s development and delivery. This Route 66 Community Health Worker group collaborated with stakeholders from public health agencies, hospitals, nonprofits, and higher education.
The Route 66 Community Health Workers drew from their community experiences and identified topics for the training curriculum that were most relevant to the unique services that CHWs provide. They referenced roles and competencies in the Community Health Worker Core Census Project (C3 Project)5 which are based on research and best practices and vetted by CHW associations and networks across the country. The group then examined the unique aspects of the people in the communities they served, considering things like culture, language, and other community contexts so that their curriculum was culturally relevant in content and delivery.
The Route 66 CHWs also had the foresight to address what could have become a challenge to creating a standardized yet relevant curriculum. CHWs are able to navigate within the unique context of a community and can become specialized in the niche in which they serve, and their clients experience different health conditions and represent diverse ages and ethnic groups. By communicating with the CHWs throughout the development and delivery of the training, Route 66 members found common ground between every CHW despite these variables.
The Route 66 Community Health Workers’ collaboration sparked collective energy to expand impact across the state. The Oklahoma Public Health Association’s (OPHA) CHW Section has worked on state CHW certification legislation for years. The Route 66 CHWs shared their curriculum and training work with OPHA to demonstrate that the profession was ready to formalize and implement state certification. The group also advocated for ongoing capacity building and peer support, which led OPHA to waive participation fees in their CHW Section meetings.
These collective efforts have contributed to the groundswell toward the goal of achieving state certification for Community Health Workers in Oklahoma. The CHW certification bill was on track for approval in the 2020 legislative season, but was cut short due to the COVID-19 pandemic. The Route 66 CHWs and other advocates statewide are committed to working to get the bill passed in the next session. Despite this setback, the pandemic also led to new opportunities. The trained CHWs in Tulsa County were integral in providing COVID-19 testing and culturally sensitive outreach to its Hispanic, Latino, Burmese, and Zomi communities. Their efforts have been so successful that they are now advocating for CHW COVID-19 services in the public school system and with restaurant workers.
5. Roles & Competencies | CHW Core Consensus Project (c3project.org)