INCHWA is bringing together those in the community who work daily to encourage the health and well-being of their neighbors. Although they are called by many different job titles and roles, CHWs are always a trusted member of their community - sought after sources of information and assistance by those in need. Often unnoticed, they play a vital role in today's healthcare system. Their work has been documented and proven effective to break down cultural barriers for clients and health care providers. Their ability to provide education and resource assistance has led to improved health outcomes for patients and cost savings to the healthcare provider. INCHWA is uniting those that recognize the importance of Community Health Workers in today's health care system and giving them a voice to promote their presence and their value as a community that cares.
History of INCHWA Initiative
Efforts to organize, train, and credential CHWs began in earnest in the early 1990s. Training programs began at community health centers in Boston and San Francisco. The New Mexico Community Health Worker Association was founded with support from the University of New Mexico and created a training program with a grant from the Robert Wood Johnson Foundation (Love, 2004). The Centers for Disease Control and Prevention (CDC) and the Department of Education provided federal grants for the development of educational curricula. Arizona and Kentucky used annual state appropriations to fund CHW programs; the former has focused on maternal and child health issues in specific communities since 1992 (Arizona Department of Health Services, 2013), while the latter has targeted medically needy individuals in selected poor and rural counties across the state since 1994 and is administered by the University of Kentucky (University of Kentucky Center of Excellence in Rural Health, 2013).
The first effort to describe the profile of CHWs on a national basis, the National Community Health Advisor Study, was released in 1998 (Rosenthal, 1998). As previously mentioned, in 2009 the U.S. Dept. of Labor recommended the establishment of a Standard Occupational Classification for CHWs (Office of Management and Budget, 2008). And in 2010 the Patient Protection and Affordable Care Act passed which included language that specifically identified CHWs as health professionals, while also authorizing grant funding for the use of CHWs to support medically underserved populations (PPACA, 2010). In addition to national activities, several states have been particularly active in developing public policy around CHWs, most notably Massachusetts, Minnesota, Oregon, and Texas.
INDIANA PUBLIC HEALTH
- Indiana State Department of Health began a research project to define CHWs in Indiana
- First statewide meeting to develop the CHW workforce was held
- CHW Coalition plan was developed
- Assessment survey of CHW landscape was conducted in both English and Spanish
- CHW Coalition literature, website, and Facebook were launched
- CHW Symposium was held to share assessment survey findings
- Districts were defined to better organize the CHW movement
- CHW Coalition became the Indiana Community Health Workers Association (INCHWA)
- Coalition Co-Chairs– Lounetta Clawson, Raquel Castro, Amparo Caudell, Dawn Galbreath, Judy Jacobs, and Margarita Hart- revive the coalition
- Margarita Hart is named INCHWA Interim Coordinator and is tasked with leading Staging Phase
- Strategic plan, scope of practice, coordinator job description, and Internet presence are developed
- ISDH provides INCHWA with seed funding
- INCHWA incorporates
- Margarita Hart is appointed President
- Board is established to direct governance of INCHWA
- Regional Directors are recruited to offer operational direction
- ISDH provides funding for the implementation of a strategic plan developed in the staging phase
- INCHWA develops strategy to become the certifying body for CHWs in the state of Indiana
- INCHWA continues developing the network of CHWs around the state
- INCHWA places Regional Directors in 9 of 10 regions
- County Chairs are recruited to help represent each county's workforce
- Education Committee is developed to aid in developing process to certify CHWs
- February: INCHWA is designated as the certifying body for CHWs in Indiana by the ISDH
- Certification process is piloted and HealthVisions Midwest becomes the first INCHWA-approved Training Vendor of Certified CHW curriculum
- Research study is completed to assess employer knowledge of CHWs and to understand barriers to hiring CHWs
- October: Indiana’s Governor builds a CHW Taskforce— co-chaired by ISDH and DWD— that is charged with defining CHWs and the certification process for the state, including securing reimbursement for CHWs. INCHWA is invited to sit on this Taskforce and share past work.
- HealthVisions Midwest certifies 133 CHWs under Skill UP grant and places them in jobs around the state
- Office of Medicaid Policy and Planning (OMPP) announces reimbursement opportunities for CHWs
- Curriculum certification process is updated to align to national and state (as defined by the CHW Taskforce) core competencies and skills
- Conversations are had with the APHA CHW Section regarding creating policy to establish a national definition for CHWs and to standardize the credentialing and monitoring of CHW work
- March: The Governor’s Taskforce causes a temporary hold on various activities including certification of additional Training Vendors as we wait to see what decisions the sate makes in terms of how CHWs will be certified and who will take on oversight of certification
- “Photo Voice Project” highlighting the everyday work of CHWs, attitudes and barriers of employers, clients, health providers and payers is completed by PhD student Ryan Logan in collaboration with INCHWA
- Skill UP2 Project ends with 86% of employers reporting that employees who participated in the SkillUP program performed better or equal to others in their organizations. 98% of the participants felt the training and program helped prepare employees for their job as a CCHW
- INCHWA resumes certification process under direction from ISDH
- Manchester University becomes the second INCHWA-approved Training Vendor
Vision for the Future
As the complex needs of people facing the double burden of health issues and socioeconomic difficulties are increasingly identified and addressed, the importance of community-level health and social services is magnified. Improvement methods can be applied at the community level to address the quality and coverage of health and social welfare services, strengthen linkages between the community and the health system, and enhance the capacity of existing groups and networks to overcome health issues in their own communities.
A particular area of focus for improvement in community health is strengthening the effectiveness and sustainability of programs that rely on community health workers (CHWs). Due to large catchment areas and numbers of households, they are expected to cover, CHWs are frequently unable to provide services to all households needing them. Although CHWs are usually linked to facilities, facility healthcare teams often do not have the time or capacity to address the challenges CHWs face. Leveraging existing networks and indigenous structures to work together to improve the health of community members can improve the acceptance of CHWs in the health care model and boost CHW morale and performance.