Don’t change who we are but give us a chance: confronting the potential of community health worker certification for workforce recognition and exclusion

Abstract

Background For community health workers (CHWs) and promotores de salud (CHWs who primarily serve Latinx communities and are grounded in a social, rather than a clinical model of care), the process of certification highlights the tension between developing a certified workforce with formal requirements (i.e., certified CHWs) and valuing CHWs, without formal requirements, based on their roles, knowledge, and being part of the communities where they live and work (i.e., non-certified CHWs). California serves as an ideal case study to examine how these two paths can coexist. California’s CHW workforce represents distinct ideologies of care (e.g., clinical CHWs, community-based CHWs, and promotores de salud) and California stakeholders have debated certification for nearly twenty years but have not implemented such processes. Methods We employed purposive sampling to interview 108 stakeholders (i.e., 66 CHWs, 11 program managers, and 31 system-level participants) to understand their perspectives on the opportunities and risks that certification may raise for CHWs and the communities they serve. We conducted focus groups with CHWs, interviews with program managers and system-level participants, and observations of public forums that discussed CHW workforce issues. We used a thematic analysis approach to identify, analyze, and report themes. Results Some CHW participants supported inclusive certification training opportunities while others feared that certification might erode their identity and undermine their work in communities. Some program managers and system-level participants acknowledged the opportunities of certification but also expressed concerns that certification may distance CHWs from their communities. Program managers and system-level participants also highlighted that certification may not address all challenges related to integrating CHWs into health care systems. CHWs, program managers, and system-level participants agreed that CHWs should be involved in certification discussions and decision making. Conclusions To address participant concerns, our findings recommend California stakeholders build a voluntary certification process structured with multiple pathways to overcome entry barriers of traditional certification processes, maintain CHW identity, and protect diversity within the workforce. Positioning CHWs as decision makers will be critical when designing state certification processes.

Perspectives on certification of community health workers: A statewide mixed‐methods assessment in Nebraska

“…This would also allow CHWs to seek standardized wages and employers to develop insurance reimbursement infrastructure. This is further supported by other CHW assessments, including an assessment in California, where CHWs identified that certification may provide enhanced professional recognition, upward mobility, and higher compensation (Anabui et al, 2021;Ibe et al, 2020;Kissinger et al, 2022).…”

“…Other reasons include the loss of CHW identity and job‐specific training requirements. This has been substantiated in the literature, where there is concern that certification will prevent CHWs from obtaining employment or accessing minority populations (CDC, 2019; Clary, 2015; Ibe et al., 2020; Kissinger et al., 2022).…”

“…The actual numbers of CHWs might have been underestimated due to various definitions of CHWs that emerge outside of specific BLS occupational codes, and a large portion of the workforce working as unpaid volunteers. As the workforce continues to grow, there have been discussions at the national level to standardize the roles and responsibilities of CHWs, especially considering the lack of workplace validation, accountability, and reimbursement for the services provided by CHWs (Anabui et al., 2021; CDC, 2019; Ibe et al., 2020; Jones et al., 2021; Kissinger et al., 2022).…”

“…roles and responsibilities of CHWs, especially considering the lack of workplace validation, accountability, and reimbursement for the services provided by CHWs (Anabui et al, 2021;CDC, 2019;Ibe et al, 2020;Jones et al, 2021;Kissinger et al, 2022).…”

Interprofessional collaboration between social workers and community health workers to address health and mental health in the United States: A systematised review

“…Lack of reimbursement models for SW is also a problem in our current healthcare financing. Further, we need to be familiar with the ongoing dialogue in the CHW field regarding certification and whether it will threaten CHW identity by removing them from the community through professionalisation or exclude some CHWs due to eligibility requirements (Kissinger et al, 2022). As the field of social work has had to grapple with similar dilemmas in the fee-for-service healthcare system, it will be important to continue advocating for collaboration and recognise that several models of collaboration may emerge due to differences in community settings or policy contexts.…”