Effective management of community health workers and promotores de salud

Community Health Workers, commonly known by many job titles (notably Promotor(a) de Salud), are a growing force in public health and health care services to minority communities, yet many organizations know little about how to manage them most effectively.   Numerous organizations including the IOM, the AMA and APHA have endorsed a greater role for CHWs in reducing disparities and improving access for underserved communities.

Several States have moved to standardize the occupation; a proposal is before the Labor Department to create a job classification for CHWs; a provider code has been created for CHWs by the National Uniform Claims Committee; a recent HRSA workforce study estimates the CHW workforce at over 120,000 in 2005.  The State of Minnesota recently received CMS approval for broad-based Medicaid reimbursement of providers for CHWs’ services.

Yet most CHWs are employed in small, short-term, grant-funded projects which do not capitalize on their full potential.  Training is mostly idiosyncratic to the employer and focused on narrow project objectives.  While there are many experienced and successful supervisors of CHWs around the country, many others are unprepared when they take on these responsibilities.

Successful management and supervision of CHWs requires an understanding of the range of their capabilities; the essential attributes of a good candidate for hiring; successful recruitment and selection strategies; generic skill requirements and training resources; the needs of CHWs around stress, boundaries and ethical challenges; methods for quality assurance in CHW practice; and appropriate recognition and career advancement strategies.  Skill development, for example, should include cultural competence, even though CHWs are generally hired for their personal experience of the culture of the community served: today’s communities are ALL becoming more diverse, and few CHWs work exclusively with people of the same cultural background.

This workshop will survey these topics and invite participants to create their own plans for more successful integration of CHWs into their organizations.  We will also review emerging national guidelines for CHW education and capacity-building, and expanded roles for CHWs in research and evaluation.  The difficult topic of CHWs as language interpreters will also be addressed: without adequate preparation for the interpreter role, CHWs may find themselves out of their vocabulary “comfort zone,” and may also experience role conflicts.

Brief versions of this workshop have been presented to audiences of health educators, nurses and health care administrators, and the presenter has worked with local, state and national organizations on effective strategies for employment of CHWs.