ASPIN Network's Community Health Worker Program
- Need: Improved approach in addressing the behavioral health and primary care disparities of Indiana’s underserved rural counties by increasing access through health insurance enrollment and providing health literacy education.
- Intervention: A network was established that dually trained community health workers (CHW) and certified health insurance enrollment navigators to aid in behavioral health and primary care services.
- Results: This year, ASPIN trained 49 CHWs, cross-trained 191 behavioral health case managers as CHWs, and 175 individuals in the Indiana Navigator Precertification Education.
Established in 1995, The Affiliated Service Providers of Indiana Network (ASPIN) serves all 92 Indiana counties including 46 with rural designation.
A network of dually trained community health workers and insurance enrollment navigators was formed to serve the rural health professional shortage areas. The program began in 2009 with the creation of the Certified Recovery Specialist (CRS) Program. In 2013, the Indiana Division of Mental Health and Addiction partnered with the State Department of Health to review an additional certification process for CHWs. Building on the 2009 program, both CHWs and CRSs became eligible for specialized cross-training of mental health workers.
Within their specified scope of practice, the work performed by the CHW/CRSs is reimbursable through Medicaid Rehabilitation Option funds within community mental health centers. In 2018, the Indiana Division of Mental Health moved the primary record keeping function to a new entity; however, ASPIN continues to be the lead trainer for CHWs statewide through an e-learning format.
The network provides training and certification of community health workers (CHWs) through Indiana's Integrated Care Community Health Worker and Certified Recovery Specialist Training and Certification Program. In addition, this program offered CHWs two separate navigator certifications: an Indiana navigator certification, and a Federal Marketplace navigator certification.
ASPIN received funding from the Indiana Division of Mental Health and Addiction to develop the state's Certified Recovery Specialist program. The network was awarded a Rural Health Network Development Grant and a Rural Health Outreach Grant to hire navigators/CHWs. Additionally, ASPIN received HRSA funding to provide training for dually certified CHW and Chronic Care Professionals.
ASPIN provides 3 training levels. Level One is a state-approved vendor for online and face-to-face CHW training. Level Two training involves CHW/Navigator training. Level Three includes some on-the-job experience.
Level One CHW training and certification provides:
- Community Health Worker concentration, a 3-day course
- Community Health Worker concentration, a 20-hour
- Community Health Worker/Certified Recovery Specialist concentration, a 5-day course available to people in recovery from a mental health and/or substance abuse diagnosis
- Addition of a gambling or substance abuse endorsement to a CHW or CHW/CRS designation that targets recovery from a gambling or substance abuse disorder
- Updated Community Health Worker Training meets the Veterans Administration, SAMHSA, INCHWA, and HRSA core competencies for peer training
Level Two ASPIN CHW/Navigator Network training provides:
- ASPIN CHW training to become Federal Marketplace and State certified Navigators to serve 14 rural counties
- 3-day CHW training in rural areas via online
- 8 hour Indiana Navigator Pre-Certification Training for the Indiana Department of Insurance (in-person or e-learning)
- Navigator continuing education courses approved by Indiana Department of Insurance through e-learning for rural sites
Level Three ASPIN CHW/ Navigator/Chronic Care training provides:
- ASPIN CHW training to become Federal Marketplace and State Certified Navigators to serve 14 rural counties
- 3-day CHW training in rural areas via online training
- 20 modules of self-study and online testing for a Chronic Care Program Certification
- Job shadowing at a primary care and a mental health facility (optional)
Level One Training Results: (as of May, 2018):
- 452 active CHWs were listed in ASPIN's database, including 65 veterans; 229 of them are dually certified as a CHW/CRS
- 30 active CHW/CRSs have received additional training for a substance abuse endorsement, a gambling endorsement, or both
- For current year, ASPIN has trained 49 CHWs
Level Two Training Results (from 9/2014-05/2018):
- Cross training of 191 behavioral health case managers as CHWs
- Development of 6 Indiana Navigator Continuing Education Courses taken by 273 individual
- 175 individuals from 31 organizations trained in Indiana Navigator Precertification Education
- Enrollment over 6,488 individuals in qualified health plans or Medicaid
- Provided over 8,289 appointments to assist consumers with health insurance enrollment or health insurance utilization question
More details about each CHW designation are available through ASPIN.
The Indiana Veterans Behavioral Health Network is also featured as one of RHIhub's Rural Health Models & Innovations.
Stakeholder diversity required consensus building to develop the CHW and CHW/Certified Recovery Specialist curricula. Stakeholders represented the following fields: academia, public health, the recovery community, state agencies, and field experts.
Consensus building was also a challenge due to the variations of CHWs throughout many healthcare specialties. There is not a national certification for CHWs, so each state defines their own state-specific policy.
The current curriculum contains some elements that are Indiana-specific. However, module topics are easily adapted to other environments.
The curriculum targets individuals seeking paid employment. Policies relating to participant selection, certification achievement, and retention are embedded within the program.
Funding combinations from state (CHW certification program) and HRSA Rural Healthcare grants (provision of hands on services) provides a unique model for CHW training and implementation. Reimbursement for CHW services are being implemented at the state level, so those wishing to replicate this model should work closely with state Medicaid offices to assist with policy development and implementation.
Community health workers
Networking and collaboration
March 18, 2014
June 7, 2018
Please contact the models and innovations contact directly for the most complete and current information about this program. Summaries of models and innovations are provided by RHIhub for your convenience. The programs described are not endorsed by RHIhub or by the Federal Office of Rural Health Policy. Each rural community should consider whether a particular project or approach is a good match for their community’s needs and capacity. While it is sometimes possible to adapt program components to match your resources, keep in mind that changes to the program design may impact results.