The American Public
Health Association defines
a community health worker (CHW) as:
“...a frontline public health worker who is a trusted member of and/or has an unusually close
the community served.”
They are critically important in rural areas where health services are limited, particularly culturally
appropriate and individualized services. CHWs often share characteristics with the population they serve, such
ethnicity, socio-economic status, language, or medical condition. While CHWs have traditionally worked with
racial and ethnic minority populations, in recent years they have come to serve a wider variety of rural, urban,
CHWs in rural areas work to improve healthcare outcomes by facilitating healthcare access, adding value to the
healthcare team, and enriching the quality of life for their patients and clients, including those who are poor,
underserved, and in racial and ethnic minority communities. CHWs act as a liaison between providers and
consumers in rural and
urban communities. Services may include:
- Culturally-appropriate health and prevention education
- Referrals for a wide range of health and social services
- Assistance in navigating the health services system and in coordinating care
- Advocating for individuals and communities within the health and social service system
- Tracking and supporting progress in managing chronic conditions and achieving health goals
- Basic health screening tests
This topic guide provides resources that identify different CHW models, demonstrate effective CHW programs, and
outline the issues and challenges to the development of CHW programs.
Frequently Asked Questions
Are community health workers officially recognized members of the healthcare
Community health workers are recognized by the U.S. Department of Labor (DOL) as health professionals and as an
essential part of cost-effective healthcare systems. In 2009, the Bureau of Labor Statistics assigned the unique
Standard Occupational Classification (SOC) code 21-1094 for community health workers.
In 2010, the Affordable Care Act (ACA) recognized CHWs as members of the healthcare workforce to promote healthy
behaviors and outcomes, by increasing access to preventive services under Medicaid and implementing regulations
allowing non-licensed healthcare workers such as CHWs to provide these services. Also, other Medicaid programs
were developed that utilize CHWs in their staffing. The Medicaid and CHIP Payment and Access Commission document
Coverage of Community Health Worker Services describes “health homes,” which were created to
help patients living with chronic illness, and gives information about how many states include CHWs in their
health home models.
What are the various duties/roles of community health workers?
The U.S. Department of Labor (DOL) provides a description of community
health workers that identifies a broad spectrum of the basic duties or roles:
“Assist individuals and communities to adopt healthy behaviors. Conduct outreach for medical
personnel or health organizations to implement programs in the community that promote, maintain, and improve
individual and community health. May provide information on available resources, provide social support and
informal counseling, advocate for individuals and community health needs, and provide services such as first
and blood pressure screening. May collect data to help identify community health needs.”
However, since its classification in 2009 by the DOL, the community health worker field has grown and the
occupation has been evolving. Other roles may be developed over time in order to provide better care and
education to community members, particularly as the provision of healthcare services in rural areas changes. For
additional duties and roles, see Roles of Community Health
Workers and CHW Program Models from
the Community Health Worker Toolkit. Also, The Community Health
Worker Core Consensus (C3) Project: 2016 Recommendations on CHW Roles, Skills, and Qualities provides
detailed tables listing the skills of community health workers and their role in achieving health equity and
addressing social determinants of health. The C3 Project list of roles and skills was developed with wide input
and guidance from the CHW field.
Where can I find current information and data on the types of healthcare industries that employ
CHWs and the wages paid for this occupation?
Occupational Employment and
Wages: 21-1094 Health Education Specialists and Community Health Workers, from the Bureau of Labor
Statistics, provides current and comprehensive listings of
national employment estimates and mean wage estimates for community health workers.
How can our healthcare organization start, integrate, and/or sustain a community health worker program?
The Community Health Worker Toolkit can help rural
organizations learn about and evaluate opportunities for developing a CHW program, and provides resources and
best practices developed by successful CHW programs. This toolkit comprises seven modules, each
concentrating on different aspects of CHW programs including program models, training approaches,
implementation, sustainability, and evaluation.
When integrating a CHW program into a healthcare organization, several factors should be addressed to ensure an
effective team effort. For example, the healthcare staff should understand the role of CHWs on the healthcare
team, including the extent of their services. Also, individual case conferences between healthcare team members
that include CHWs may facilitate and support integration. See Integrating Community Health Workers into Complex
Care Teams: Key Considerations for additional information regarding the recruiting, hiring, training,
and retention of CHWs.
The Association of State and Territorial Health Officials document How
Community Health Workers Are Impacting Rural Communities describes Local Health Equity Action Teams
(LHEATs), created through cooperative efforts between the Kansas Department of Health and Environment and the
University of Kansas Medical Center. Six of the 10 LHEATs are in rural counties, where the CHWs employed by the
LHEATs identify patient needs and other barriers to care, and then formulate plans to address those challenges.
Showing the benefit of the program is an important step in sustaining a CHW program. The ROI Educational Tool, offered by MHP Salud,
(free registration required to view resources) helps organizations identify the key elements for
conducting a return on investment analysis in order to prove the value of the program.
Where can I find funding to help develop a community health worker program in our rural healthcare
Healthcare facilities and local agencies often use grants or state and federal funds to pay CHWs. Although grant
funders may not specifically say they support the development of a community health worker
program, they may be clear on their mission to improve rural healthcare access and outcomes for underserved
populations through innovation and promising practices. The development of a community health worker program may
be the perfect solution to foster that mission. Programs such as the Community
Health Worker-based Chronic Care Management Program in Appalachia use grant funding for initial
operating expenses and subsequent analysis, and then use these results to encourage financial support from
multiple organizations, including making the business case for reimbursement from payers.
See our Funding by Topic: Community health workers
section for a list of funding opportunities. Also, the Grant Funding for Community Health Worker
Programs section of the Community Health Worker Toolkit includes a list of foundations, organizations,
and federal agencies that have funded CHW programs and research, and provides examples of what they have done.
The National Association of Community Health Workers document Sustainable
Financing of Community Health Worker Employment describes financing options including policy mechanisms
available under Medicaid and Medicare, alternative payment structures, demonstration waivers, and Delivery
System Reform Incentive Payments.
Increasingly, states are supporting the expansion of CHW programs with sustainable funding through Medicaid
information describing how states fund, train, and certify CHWs, see the National Academy for State Health
Policy's State Community Health
Worker Policies funding map.
How can CHW programs pay for themselves within an ACO model?
CHW programs can work well within Accountable Care Organizations (ACOs). The ACO model provides financial
incentives to organizations that efficiently and effectively manage patient care. CHWs can help ACOs improve
health outcomes while reducing the cost of care, particularly for high-utilizer patients. For additional
information on opportunities to financially support CHW programs, see CHW Toolkit:
Summary of Regulatory and Payment Processes and Affordable
Care Act Opportunities for Community Health Workers.
Do community health workers need to be certified?
Some states require community health workers to have state-level certification through completion of an
approved training program and acquisition of specific skills, but other states do not require certification. If
credentialing is required, it is often overseen by a local health department or a state-level agency.
As the community health worker profession grows, more states have developed a certification process. There is no
national CHW certification. For additional information on the certification and qualifications of CHWs at the
state level, check with the state health department or CHW association.
What kind of training do CHWs need and can a rural healthcare organization develop its own
CHW training infrastructure varies widely from state to state. Academic programs, health systems, and
community-based organizations train CHWs at various levels of instruction. Generally, the training of CHWs
depends on the needs of the community and the healthcare organization. Most CHW training programs are local and
may be employer driven. Training organizations customize their curriculum to best fit their own needs, or those
of their community. Components can include:
- Familiarity with and respect for other cultures
- Patient intake and assessment
- Screening recommendations
- Risk factors
- Insurance eligibility and enrollment
- Communication skills
- Health promotion
- Disease prevention and management
- Service coordination skills
- Use of technology
CHW training programs have increased in number in recent years, with numerous programs available across the
country. Some offer college credit while others are community based to meet the needs of the local population.
CHW continuing education programs are also expanding to include specialties, such as CDC's training focused on
the prevention of heart disease and
stroke as well as training on the management of patients
with complex diabetes offered through videoconferencing technology from New Mexico's Project ECHO. There is also interest in training CHWs to support
individuals with behavioral health needs. In addition, the National Institute of Health (NIH) supports a
Health Disparities Initiative focused on reducing health disparities in underserved and minority
populations by providing health education resources and training. The Training for Community Health Workers section of
our Community Health
Worker Toolkit contains additional information on the development of a CHW training program. For information on
the certification, credentialing, and qualifications of CHWs, see The
Evolution, Expansion, and Effectiveness of Community Health Workers and Community
Health Worker: Academic Requirements. The National Association of CHWs also maintains a list of CHW training programs across
The Community Health Worker
Assessment Toolkit developed by the Community Health Worker Core Consensus Project (C3 Project) provides
information on how to track and foster CHW skills development. According to the C3 Project, assessing CHW skills
can reduce turnover, improve capacity to serve clients, and enhance effectiveness when working in a team
environment. The toolkit outlines the steps necessary to develop an assessment, and offers guiding principles
and best practices for assessing CHW skills contributed by CHW supervisors, trainers, and employers currently
Should CHW training programs be formally certified?
Not all states require certification of CHW training programs. Some states mandate a certain amount of training
from a certified trainer for an individual to work as a community health worker. The trend to standardize and
certify community health worker training programs appears to be growing.
There are advantages to developing state-certified CHW training programs by promoting a common, transferable
knowledge base that can be used in many settings. Also, by providing training that meets certain standards or
certification, CHWs may receive the recognition of other healthcare professionals and of the communities where
they serve, and better compensation.
Texas was a leader in early efforts to certify CHW training programs — see publications from the state's
this area at Promotora or Community Health Worker Training and Certification Program: 2021 Annual Report
Community Health Worker or Promotor(a) Training and
For additional information about the certification of CHW training programs, see Community Health Workers:
Opportunities in Health Care Delivery System Reform, Community
Health Worker (CHW) Toolkit: A Guide for Employers, and resources available
from the National
Association of Community Health Workers.