Need: Improved approach in addressing the behavioral health and primary care disparities of Indiana's underserved rural counties.
Intervention: A network was established that trained community health workers (CHWs) to be certified health insurance enrollment navigators and provide mental health services.
Results: This year, ASPIN trained 230 CHWs, cross-trained 70 behavioral health case managers as CHWs, and 35 individuals in the Indiana Navigator Pre-certification Education.
The Affiliated Service
Providers of Indiana Network (ASPIN), a nonprofit
behavioral health provider and education network, is the
lead trainer for community health workers (CHWs)
statewide through an e-learning format. With support from
the Indiana Division of Mental Health and Addiction and
the Indiana State Department of Health, ASPIN started a
Certified Recovery Specialist (CRS) program that offers
training for CHWs in insurance enrollment navigation,
mental health delivery, and chronic care conditions
through their Certified Community Health
Worker Training Program.
Within their specified scope of practice, the work
performed by CHWs and CRSs within community mental health
centers is reimbursable through Medicaid Rehabilitation
funds. Other healthcare providers can now also bill
Indiana Medicaid for CHW services.
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 training on chronic care
conditions and some on-the-job experience.
Level One CHW training and certification provides:
Community Health Worker concentration – a 3-day
in-person course or a 20-hour online 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
Addition of an endorsement to a
CHW/CRS designation that targets recovery from a gambling
or substance abuse disorder
Level Two ASPIN CHW/Navigator Network training provides:
ASPIN CHW training to become federal or
state-certified navigators to serve 14 rural counties
3-day CHW training in rural areas via online training
8 hour Indiana Navigator Pre-Certification Training
for the Indiana Department of Insurance (in-person or
Continuing education courses
approved by Indiana Department of Insurance through
e-learning for rural sites
Level Three ASPIN CHW/ Navigator/Chronic Care 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
The diversity of stakeholders involved in building the
CHW and Certified Community Health Worker curricula made
it more difficult to come to a consensus in some areas.
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
The current curricula contains some elements that are
Indiana-specific. However, module topics are easily
adapted to other environments.
The curricula 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
programs and HRSA rural health grants provides a unique
model for ASPIN's CHW training and implementation.
Reimbursement for CHW services have been 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. This CHW
model has been presented to over 33 different states.
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.