ASPIN Network: 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 to address behavioral health integration, which included the use of dually trained community health workers (CHW) and certified health insurance enrollment navigators.
- Results: Creation of a certification process, the “Indiana Integrated Care Training Program: Community Health Worker/Certified Recovery Specialist,” for CHWs and cross-training of mental health peers to also work as CHWs
Established in 1995, The Affiliated Service Providers of Indiana Network (ASPIN) serves all 92 Indiana counties including 46 with rural designation.
Within the scope of the Office of Rural Health Policy-HRSA funded ASPIN Health Improvement Program Rural Health Network Development Grant and ASPIN Community Health Worker Network Outreach Grant, a network of dually trained community health workers and insurance enrollment navigators was formed to serve the rural health professional shortage areas.
The program’s timeline begins 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.
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/community health workers.
ASPIN provides two training levels. Level one is the state's vendor for CHW training. Level two training involves CHW/Navigator training.
Level one CHW training and certification provides:
- Community Health Worker concentration, a 3-day course
- 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
- Site visits for CHWs and CHW/CRSs to tour potential places of employment/involvement
- Train the Trainer sessions for CHWs or CHW/CRSs who would like to function as presenters for the state-authorized curriculum
- Annual CHW/CRS full day conference
- Continuing Education Units tracking and monitoring (14 CEUs required annually)
- 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
- 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
For level one training, as of April 2017:
- 552 active CHWs are listed in ASPIN's database, including 65 veterans. Of the 552 active CHWs, 281 are dually certified as a CHW/CRS
- 32 active CHW/CRSs have received additional training for a substance abuse endorsement, a gambling endorsement, or both
- For current year, ASPIN has trained 62 CHW/CRSs and 22 CHWs
- Offsite training for current fiscal year includes 20 CRSs and 40 CHWs
- A jointly approved training curriculum, with a target of 60 individuals in recovery to be trained each fiscal year
Level Two CHW/Navigator Network Results:
Results from 9/2014-03/2017:
- Cross training of 176 behavioral health case managers as CHWs
- Development of 6 Indiana Navigator Continuing Education Courses taken by 217 individual
- 159 individuals from 27 organizations trained in Indiana Navigator Precertification Education
- Enrollment over 1,862 individuals in qualified health plans or Medicaid
- Provided over 3,088 appointments to assist consumers with health insurance enrollment or health insurance utilization question
More details about each CHW designation are available through ASPIN.
Stakeholder diversity required consensus building to develop the Community Health Worker and Community Health Worker/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.
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 (statewide CHW certification program) and HRSA Rural Healthcare Grants (provision of hands on services) provides a unique model for CHW training and implementation.
Kathy Cook, CEO/President
Community health workers
Networking and collaboration
March 18, 2014
June 5, 2017
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.