The Community Health Training Institute, Inc. is a Texas non-profit corporation based in Fort Worth. Its focus is to develop curriculum that allows lay people and other health care personnel to be trained as certified Texas Community Health Workers.
Community Health Training Institute, Inc. (CHTI) was established after several years of training and teaching Community Health Workers at the UNT Health Science Center’s School of Public Health (UNTHSC). Under the project name, Texas Public Health Training Center (TPHTC), UNTHSC trained a number of Fort Worth based Community Health Workers (CHW) for service in several local social service agencies and hospital systems.
Yara Williams of CHTI discusses the role of the Community Health Worker in today’s healthcare system.
CHTI provides relevant and innovative trainings for preparing CHW candidates to serve in diverse public health and clinical health care arenas in the community. The role of the CHW is to serve as connectors / liaisons between the community and resources. However, that role has begun to change. Addressing how CHW’s may integrate into health care and social services has begun on several levels. Studies have also addressed the cost-effectiveness of CHW’s. CHW’s help people navigate health delivery, social services and health services due to their commonalities with their communities’ language, socioeconomic status, ethnicity and community life experiences.
To become certified, a Texas certified Community Health Worker (CHW) candidate must complete one hundred sixty (160) hours of classroom training under the guidance of a certified Texas CHW Instructor. For certification, CHW instructors may only teach from a state approved curriculum. An approved CHW curriculum trains candidates in eight (8) CHW core competencies:
- Interpersonal Skills
- Service Coordination
- Capacity Building
- Health Advocacy
- Knowledge Based Skills – Specific Knowledge of Chronic Diseases
- Teaching Skills
- Organizational Skills
Why Are CHW’s Important?
Noelle Wiggins, Director of the Community Capacitation Center of Multnomah County Health Department in Portland, Oregon launches the revised CHW Central with her thoughts:
“At this crucial time of possibility and change, it is essential that US CHW’s and their advocates work to maintain the characteristics of the CHW model that have made it so very effective over time and around the world. These characteristics include CHW’s membership in the communities they serve and their ability to play multiple roles, from providing culturally specific health education and information, to sharing informal counseling and social support, to organizing communities to identify and address their own most pressing health issues.”
Scope of Service For Community Health Workers
Community Health Workers are considered frontline community members of many communities. They serve as liaisons between the community members and health and social service agencies.
Community Health Workers (CHW) create bridges to community services that create capacity change in communities that involve a multi-sectoral approach. Studies have shown CHW’s are effective in promoting behavioral changes in the clients they serve by increasing utilization rates and providing significant reduction in hospital admissions and readmissions (Fedder, Chang, Curry, 2003). CHW’s are responsible for:
- Promoting Cultural Competency
- Helping Individuals, Families, Groups and Communities Develop Capacity and Access To Health and Human Services Organizations / Agencies
- Facilitating Communications and Client Improvement Within the Health and Human Service Domain
- Helping Individuals Understand Their Health Conditions
- Helping People Develop Strategies To Improve Their Health and Well-Being
- Delivering Health Education Information Using Appropriate Culturally Competent Terms and Concepts
- Linking People to Health Care and Social Service Resources
- Providing Informal Counseling Support and Follow-Up
- Advocating For Individuals
- Providing Health Services Such As Monitoring Blood Pressure
- Making Home Visits To the Elderly and Chronically Ill Patients As Well As Those Classified As High Risk
- Translating Services
- Case-Management Service (Source, Explore Health Careers.org)
CHW’s and Health Care Teams
The role of CHW’s is well aligned with the goals of Community Care Teams, Primary Care Teams and Medical Homes around care coordination and access to care. CHW’s integration into primary care teams with doctors, nurses and other providers may help “magnify” the team’s effects. According to a review by the Centers for Disease Control and Prevention, evidence suggests that including CHW’s in health care teams can extend the reach of CHW’s and have a positive effect on patient health. Integrating CHW’s into multi-disciplinary health care teams can be financed through mechanisms such as Medicaid, Medicare or private insurers.
In West Virginia, for example, CHW’s are listed as possible members of the state’s Health Home initiative care-provider teams, which are reimbursed by Medicaid through preset payments per member. As team members, CHW’s help provide services such as follow-up care after patient discharge to avoid the need for additional medical services. CHW’s are similarly integrated in Vermont’s Community Health Teams, whose services are paid for by Medicaid, Medicare and the state’s major insurers. Vermont’s Blueprint for Health, a statewide public-private partnership focused on improving health care, uses CHW’s to provide a variety of services, such as attending medical appointments with patients and assisting with transportation or child care.
Community Health Worker Definitions and Roles
CHW’s are considered to be the “frontline public healthcare workforce” and the most versatile members of the health care community. CHW’s perform a diverse set of roles and functions as well as carry a variety of titles including “community health advisor, outreach worker, community health representative (CHR), promotora/promotores de salud (health promoter/promoters), patient navigator, navigator promotores (navegadores para pacientes), peer counselor, lay health advisor, peer health advisor and peer leader.” Source – CDC, 2015
Definition of a Community Health Worker, American Public Health Association:
Community Health Workers are frontline public health workers who are trusted members of the community and/or have an unusually close understanding of the community served. This trusting relationship enables CHW’s to serve as a liaison, link or intermediary between health/social services and the community to facilitate access to services and improve the quality and cultural competence of service delivery. CHW’s also build individual and community capacity by increasing health knowledge and self-sufficiency through a range of activities such as outreach, community education, informal counseling, social support and advocacy.
Source – American Public Health Association