Often, people ask, “What is a community health worker? Who are they? What do they do? And how do they do it?”
Are they outreach workers, peer educators, promotores, or even tribally based community health representatives? There seem to be so many different names.
Those names reflect the diversity of the CHW field and mirror the many distinct settings and communities where CHWs serve.
Are there paid CHWs and other CHWs who get stipends or even volunteer?
Well, mostly CHWs are paid. Hopefully, they are paid a good living wage with benefits. Some CHWs volunteer because there is still limited, stable funding for CHWs, and some volunteer because they want to give their time to their community.
Even with all these differences among CHWs, hopefully you know a lot about what CHWs have in common.
One thing you should know is that even if CHWs are not all paid, or not all paid the same, CHWs are deeply committed to supporting the individuals and families where they live and work. They are part of a continuum of caring.
Another important thing that CHWs share in common is their core roles and competencies, including their skills and qualities.
Many people have looked to the 1998 National Community Health Advisor Study for a starting point. The study identified seven core roles that helped define CHW scope of practice.
These roles include cultural mediation, health education, assuring access to health care and other services, informal counseling and social support, individual and community advocacy, provision of direct services, meaning health screenings and basic first aid, and individual and community capacity building to strengthen and support the skills and abilities of individuals and communities.
Programs and policies to support CHW service development should ideally position community health workers to fulfill a wide range of their core roles.
What happens if CHW roles are too narrowly defined?
Let’s take a look at what happens when a CHW works in a narrowly defined role.
If a CHW teaches Diabetes 101 in a classroom but does not have the opportunity to talk with those attending the session, she could not offer social support.
Given this narrow role of health educator, the CHW might not touch the lives of those she serves, and the participants might once again be overwhelmed with the medical information about their chronic condition.
They will miss the benefit of an informed ally who they can talk to about the changes they want to make and how hard it is to make them. Their condition is poorly controlled, and they may find themselves in the emergency room once again.
If we want community health workers to carry out a wide variety of roles within the community, we need to make sure their training gives them the right skills.
Dr. Noel Wiggins, who led the examination of roles and competencies for the National Community Health Advisor Study, identifies eight core skills that CHWs need. These include communication skills, interpersonal skills, service coordination skills, capacity building skills, advocacy skills, teaching skills, including facilitation, organizational skills, including setting goals, planning, documenting and research, and a general knowledge base, including knowledge about the community, specific health issues, and health and social service systems.
The study also found that CHWs have many important qualities. The most unique and important of which is that CHWs are closely connected to the community they serve, sharing life experience.
You may wonder whether these roles and competencies represent today’s reality for CHWs as they did more than 16 years ago when the National Community Health Advisor Study was released.
That is the purpose of the National Community Health Worker Common Core Project, also known as the C3 Project.
Many of the same people who worked on the National Community Health Advisor Study are part of the C3 Project. The C3 Project is focused on building forward from the National Community Health Advisor Study to offer contemporary guidance on CHW roles and skills that support the work CHWs do today.
You may also wonder, what about guidance from the C3 Project on CHW qualities?
The C3 Project recognizes the importance of the qualities that make CHWs effective, including their close connection to the community. The project team, like others, recognizes that those qualities are timeless and have not, and will not, change.