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- Herausgeber: John Wiley & Sons
- Kategorie: Fachliteratur
- Serie: Jossey-Bass Public Health/Health Services Text
- Sprache: Englisch
A practical guide to becoming a community health worker Foundations for Community Health Workers provides a practical and comprehensive introduction to essential skills for professionals in community health roles. In the wake of the COVID-19 pandemic, there is a greater need than ever for compassionate community health workers trained in the core competencies and guiding principles that can empower individuals to lead healthy lives. With an emphasis on social justice, cultural humility, and client-centered practice, this book offers a solid background in professional skills and their application. Real-life case studies and quotes from community health workers illustrate the challenges and successes that learners will face on the job. Readers will also gain skills in conflict resolution, group facilitation, community organizing, trauma support, and more, equipping them to enter the public health field with confidence and safety. * Learn about the public health field and the skills needed to become a community health worker * Gain skills in interacting with people from diverse backgrounds and circumstances * Develop a background in client interviewing, community advocacy, and facilitating community health trainings * Read case studies from real community health workers This book, in its updated Third Edition, is a valuable introduction and reference for anyone working toward a career as a community health worker.
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Seitenzahl: 1869
Veröffentlichungsjahr: 2024
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Table of Contents
Cover
Table of Contents
Title Page
Copyright Page
Acknowledgments
Contributors
About the Companion Website
I Introduction
Why the C3 Project?
References
PART 1: COMMUNITY HEALTH WORK: THE BIG PICTURE
1 The Role of Community Health Workers—Serving with Skills and Compassion
Introduction
1.1 Who Are CHWS and What Do They Do?
1.2 CHWs and Public Health
1.3 Roles and Competencies of CHWs
1.4 The Role of CHWs in the Management of Chronic Conditions
1.5 The Role of CHWs in Promoting Language Access Justice
1.6 Professionalizing the Work
1.7 Introducing 23 CHWS
Chapter Review
References
Additional Resources
2 The Evolution of the CHW Field in the United States
Introduction
2.1 Neighbor Assisting Neighbor
2.2 CHW Names, Definitions, and Competencies
2.3 CHWs’ Evolution in the United States
2.4 Trends in the CHW Field
2.5 CHW Workforce Policy
2.6 Convening CHWs: Nothing About Us Without Us
Chapter Review
References
Additional Resources
3 An Introduction to Public Health
Introduction
3.1 Defining Health
3.2 Defining the Field of Public Health: Key Concepts
3.3 The Practice of Public Health
3.4 Public Health and Social Justice
Chapter Review
References
Additional Resources
4 Promoting Health Equity
Introduction
4.1 Defining Health Equity
4.2 Social Determinants of Health
4.3 Health Inequities Between Communities
4.4 Public Health and Social Justice
Chapter Review
References
Additional Resources
PART 2: CORE COMPETENCIES FOR PROVIDING DIRECT SERVICES
5 Guiding Pr inciples: Self‐Awareness, Ethics, Professional Boundaries, and Teamwork
Introduction
5.1 Duty of Self‐awareness
5.2 Ethical Guidelines for CHWs
5.3 Scope of Practice
5.4 Upholding Professional Boundaries
5.5 Multidisciplinary Teamwork
Chapter Review
References
Additional Resources
6 Behavior Change and Person‐centered Practice
Introduction
6.1 Understanding Behavior Change
6.2 Person‐centered Practice
Chapter Review
Reference
Additional Resources
7 Practicing Cultural Humility
Introduction
7.1 Defining and Understanding Culture
7.2 Defining Cultural Humility
7.3 Practicing Cultural Humility
7.4 The Culturally Diverse Context for Community Health Work
7.5 Histories of Discrimination
7.6 Building Capacity as Culturally Effective CHWS
7.7 Cultural Health Beliefs
7.8 Professional Roles of Culturally Effective CHWs
Chapter Review
References
Additional Resources
8 Conducting Initial Client Assessments
Introduction
8.1 An Overview of Initial Client Assessments
8.2 The Beginning of The Assessment
8.3 The Middle of The Initial Assessment
8.4 The End of the Assessment
8.5 Documenting Client Assessments
Chapter Review
Reference
Additional Resources
9 Person‐Centered Counseling and Motivational Interviewing
Introduction
9.1 An Overview of Person‐Centered Counseling
9.2 Developing an Action Plan
9.3 Knowledge and Skills for Person‐Centered Counseling
9.4 Motivational Interviewing
9.5 Additional Resources for Person‐Centered Counseling
9.6 Common Challenges
9.7 Teamwork and Supervision
9.8 Self‐Awareness
9.9 Self‐Assessment
9.10 Creating a Professional Development Plan
Chapter Review
References
Additional Resources
10 Case Management
Introduction
10.1 Defining Case Management
10.2 Basic Case Management Concepts
10.3 Developing the Case Management Plan
10.4 Other Suggestions for Effective Case Management
10.5 Common Case Management Challenges
10.6 Identifying Community Resources and Providing Referrals
10.7 Advocacy
10.8 Organizing and Documenting Your Work
10.9 Team Meetings and Case Conferences
10.10 Supervision
Chapter Review
References
Additional Resources
11 Conducting Home Visits
Introduction
11.1 An Overview of Home Visits
11.2 Preparing to Conduct a Home Visit
11.3 Common Courtesies and Guidelines
11.4 Safety Guidelines for Home Visits
11.5 How to Conduct a Home Visit
11.6 After the Visit
11.7 Common Challenges
Chapter Review
References
Additional Resources
PART 3: ENHANCING PROFESSIONAL SKILLS
12 Stress, Health andSelf‐Care
Introduction
12.1 Defining Stress
12.2 Internal and External Resources
12.3 Stress Responses
12.4 Burnout and Post Traumatic Stress
12.5 Assessing Risks for Stress and Burnout
12.6 Stress Management Strategies and Resources
12.7 Enhancing Stress Management Skills
12.8 Self‐Care
12.9 Talking with Clients about Stress Reduction
Chapter Review
References
Additional Resources
13 Conflict Resolution
Introduction
13.1 Defining Workplace Conflict
13.2 Consequences of Workplace Conflict
13.3 Common Responses to Conflict
13.4 Common Challenges to Resolving Conflict
13.5 Communication Skills for Conflict Resolution
13.6 Approaches to Prevention and Resolving Workplace Conflict
13.7 Equity and Conflict Resolution
13.8 CHW Leadership
Chapter Review
References
Additional Resources
14 Professional Skills
Introduction
14.1 The Challenges of Code Switching and the Imposter Syndrome
14.2 Career Readiness
14.3 Keeping the Job
14.4 Professional Development and Career Advancement
Chapter Review
References
Additional Resources
PART 4: APPLYING CORE COMPETENCIES TO KEY HEALTH ISSUES
15 Health Care Is Reentry
Introduction
15.1 Basic Terms and a Note on Language
15.2 The Roots of U.S. Incarceration Policies
15.3 The Health Impacts of Incarceration
15.4 The Impact of Incarceration on Families and Communities
15.5 The Challenges of Reentry or Coming Home
15.6 The Role of CHWs
15.7 Best Practices and Emerging Models
15.8 Continued Professional Development
Chapter Review
References
Additional Resources
16 Chronic Conditions Management
Introduction
16.1 Defining Chronic Conditions
16.2 Chronic Conditions and Health Inequities
16.3 Factors That Cause and Contribute to Chronic Conditions
16.4 The Consequences of Chronic Conditions
16.5 Treatment Options
16.6 How to Stay Informed About Chronic Conditions
16.7 Emerging Models for Chronic Conditions Management
16.8 Integrating Medicine and Public Health Models
16.9 Team‐based Approaches to Chronic Conditions Management
16.10 Population Health Management
16.11 Patient Self‐Management
16.12 Chronic Conditions and the CHW Scope of Practice
16.13 Applying Person Centered Concepts and Skills
16.14 Action Planning for Chronic Conditions Management
16.15 Medication Management
16.16 Responding to Ambivalence and Relapse
16.17 Follow‐up Services
16.18 Ending Services
Chapter Review
References
Additional Resources
17 Promoting Healthy Eating and Active Living
Introduction
17.1 What We Eat and Drink
17.2 Common Barriers to Changing Our Diets
17.3 Weight and Health
17.4 Understanding Information about Nutrition
17.5 Guidelines for Healthy Nutrition
17.6 Practical Guidelines for Healthier Eating
17.7 Approaches to Providing Health Education About Nutrition
17.8 Physical Activity
17.9 Guidelines for Healthy Activity
17.10 Supporting Clients to Increase Activity Levels
Chapter Review
References
Additional Resources
18 Supporting Survivors of Trauma
Introduction
18.1 Defining Trauma and Post‐traumatic Stress
18.2 Post‐Traumatic Stress Disorder (PTSD)
18.3 A Common Language for Trauma Responses
18.4 How Culture and Status Influence Trauma
18.5 Healing from Trauma
18.6 The CHW Scope of Practice
18.7 Guidelines for Working with Survivors
18.8 Conducting a Suicide Assessment
18.9 Trauma‐informed Care
18.10 Secondary Trauma, Secondary Resilience
18.11 Self‐care
18.12 Ongoing Professional Development
Chapter Review
References
Additional Resources
PART 5: WORKING WITH GROUPS AND COMMUNITIES
19 Community Health Outreach
Introduction
19.1 Defining Community Health Outreach
19.2 Qualities of Successful Community Health Outreach Workers
19.3 Communities to Be Served Through Outreach
19.4 Health Issues Addressed by Outreach
19.5 Outreach Levels
19.6 Common Outreach Methods
19.7 Planning Health Outreach
19.8 Conducting Health Outreach
19.9 Documenting Health Outreach Services
19.10 Ethics and Health Outreach
19.11 Supervision and Support
Chapter Review
References
Additional Resources
20 Facilitating Trainings
Introduction
20.1 An Overview of Training
20.2 Understanding How People Learn
20.3 Approaches to Teaching and Training
20.4 Applying CHW Skills
20.5 Training Methods
20.6 Deciding If Training Is the Right Strategy
20.7 How to Plan and Prepare Trainings
20.8 Tips for Facilitating a Participatory Training
20.9 Responding to Common Challenges
20.10 Evaluation of Trainings
Chapter Review
Reference
Additional Resources
21 Group Facilitation
Introduction
21.1 Types of Groups
21.2 Key Considerations Before You Start a Group
21.3 The Unique Advantages of Group Work
21.4 Roles and Abilities of Group Facilitators
21.5 Establishing a Group Identity
21.6 Facilitation Techniques for Support Groups
21.7 Responding to Facilitation Mistakes and Challenges
21.8 Video‐based Groups
21.9 Co‐Facilitation
21.10 Ethics and Group Facilitation
21.11 Ending a Group
21.12 Evaluation
Chapter Review
References
Additional Resources
22 Research, Evaluation, and Dissemination of Findings
Introduction
22.1 Defining Research and Evaluation
22.2 CHW Competencies and Framework for Research and Evaluation
22.3 Selecting Research Tools and Methods
22.4 Sharing Findings with the Community
22.5 Trends in CHW Research and Evaluation
Chapter Review
References
Appendix A: Examples of CHW Roles in Research in Published Studies (*mapped to C3 Project CHW Core roles)
Appendix B: Examples of CHWs as Researchers in Published Studies
23 Community Organizing
Introduction
23.1 Overview
23.2 What Is Organizing? What Does an Organizer Do?
23.3 A Story of Grassroots Organizing in Oakland, California
23.4 Health Is Always Political
23.5 Organizing for Health and Social Justice
23.6 Popular Education
23.7 Education Equity Campaign Case Study
23.8 The Role of CHWs
Chapter Review
References
Additional Resources
C3 Project CHW Roles and Competencies Review Checklist
ROLES
C3 Roles and Skills Checklist
Video Index
Index
End User License Agreement
List of Tables
Chapter 1
Table 1.1 Common Titles for CHWs
Table 1.2 CHW Core Consensus (C3) Project Roles and Competencies
Table 1.3 Personal Qualities of Successful CHWs
Chapter 3
Table 3.1 The Spectrum of Prevention
Table 3.2 The Spectrum of Prevention Applied to Police Violence in the Unit...
Chapter 4
Table 4.1 Health Indicators for Black and White People in the United States...
Chapter 6
Table 6.1 Factors That Get in the Way of Behavior Change: An Ecological Mod...
Chapter 9
Table 9.1 The Stages of Change
Table 9.2 Examples of the Use of Reframing in Behavior Change Counseling
Table 9.3 Self‐Assessment for Person‐centered Counseling
Chapter 22
Table 22.1 Using the Scientific Method with a Physical Activity Example
Table 22.2 Description of Types of Evaluation
Table 22.3 Using the Evaluation Framework for a Case Example of a Promotora‐...
Table 22.4 Differences Between Research and Evaluation
Table 22.5 Framework for Program Evaluation in Public Health Mapped to CHW C...
Table 22.6 Guide to Writing SMART Goals for Projects
Table 22.7 Uses of Specific Research Tools and Methods
Table 22.8 Example—Summary of Themes from the Physical Activity Qualitative...
C3 Project CHW Roles and Competencies Review Checklist
Table C3.1 Community Health Worker Roles/Scope of Practice
Table C3.2 Community Health Worker Competencies: Skills
List of Illustrations
Chapter 1
Figure 1.1 The Relationship Between CHW Qualities, Roles, and Core Competenc...
Chapter 3
Figure 3.1 The Dimensions of Health
Figure 3.2 Ecological Model of Health
Chapter 4
Figure 4.1 Visualizing Health Equity, Robert Wood Johnson Foundation
Figure 4.2 Equity Compared to Equality, Kinshella
Chapter 6
Figure 6.1 Big Ears, Big Eyes
Chapter 9
Figure 9.1 Factors that Enhance and Reduce Motivation for Change.
Figure 9.2 A Simple Scale
Figure 9.3 Bubble Chart from CHW.
Figure 9.4 Professional Development Plan
Chapter 14
Figure 14.1 Sample Résumé
Chapter 16
Figure 16.1 Medication Label
Chapter 22
Figure 22.1 The Scientific Method
Figure 22.2 Health EquiTREE (Breen, 2022)
Figure 22.3 Logic Model: If … Then Statements
C3 Project CHW Roles and Competencies Review Checklist
Figure C3.1 The CHWs Roles and Competencies Support Pyramid
Guide
Cover Page
Table of Contents
Title Page
Copyright Page
Acknowledgments
Contributors
About the Companion Website
Introduction
Begin Reading
C3 Project CHW Roles and Competencies Review Checklist
C3 Roles and Skills Checklist
Video Index
Index
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FOUNDATIONS FOR COMMUNITY HEALTH WORKERS
THIRD EDITION
Tim Berthold and Darouny Somsanith, Editors
Copyright © 2024 by John Wiley & Sons, Inc. All rights reserved.
Published by John Wiley & Sons, Inc., Hoboken, New Jersey.Published simultaneously in Canada.
No part of this publication may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording, scanning, or otherwise, except as permitted under Section 107 or 108 of the 1976 United States Copyright Act, without either the prior written permission of the Publisher, or authorization through payment of the appropriate per‐copy fee to the Copyright Clearance Center, Inc., 222 Rosewood Drive, Danvers, MA 01923, (978) 750‐8400, fax (978) 750‐4470, or on the web at www.copyright.com. Requests to the Publisher for permission should be addressed to the Permissions Department, John Wiley & Sons, Inc., 111 River Street, Hoboken, NJ 07030, (201) 748‐6011, fax (201) 748‐6008, or online at http://www.wiley.com/go/permission.
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Library of Congress Cataloging‐in‐Publication Data applied forPaperBack ISBN 9781394199785ePDF: 9781394199839epub: 9781394199792
Cover design: WileyCover images: Courtesy of Amy Sullivan
Acknowledgments
We are grateful for the dedication of our 27 authors. Short biographical statements are provided for each author in the next section of the book.
Thank you to everyone who contributed a CHW Profile: Cristina Arellano, Joe Calderon, Estela Munoz de Cardenas, Lorena Carmona, Dante Casuga, Mattie Clark, Faith Fabiani, Durrell Fox, Abdul’Hafeedh bin ‘Abdullah, Fadumo Jama, Michelle James, Pennie Jewell, Floribella Martinez‐Redondo, Francis Julian Montgomery, Avery Nguyen, Silvia Ortega, Nilda Palacios, Monica Rico, Tahrio Sanford, Sengthong Sithounnolat, Porshay Taylor, Kim Lien Tran, and David Valentine.
We honor the other CHWs who contributed to the book through their quotes, photographs, and participation in educational videos, including Veronica Aburto, Victoria Adewumi, Juanita Alvarado, Leticia Olvera Arechar, Jill Armour, Kathleen Banks, Precious Beddell, Maha Begum, Lidia Benitez, Ramona Benson, John Boler, Anthony Brooks, Tomasa Bulux, Jessica Calderon‐Mitchell, Rene Celiz, Esther Chavez, Andrew Ciscel, Dorel Clayton, Phuong An Doan‐Billings, Cameron Dunkley, Rosaicela Estrada, Jaenia Fernandez, Felipe Flores, Ariann Harrison, Toni Hunt Hines, Alexander Fajardo, Darnell Farr, Tracy Reed Foster, Thomas Ganger, Jason Gee, Kayla Green, Lee Jackson, Sandra Johnson, Yemisrach Kibret, Yudith Larez, Rose Letulle, Michael Levato, Celeste Sanchez‐Lloyd, Chelene Lopez, Inez Love, Sabrina Lozandieu, Phyllis Lui, Galen Maloney, Sergio Matos, Jermila McCoy, Richard Medina, Paul Mendez, Hugo Rengifo Ochoa, Olivia Ortiz, Sophia Simon‐Ortiz, Jade Rivera, Kent Rodriguez, Keara Rodela, Romelia Rodriguez, LaTonya Rogers, Ron Sanders, Martha Shearer, Jerry Smart, Denise Octavia Smith, Abby Titter, Michelle Vail, Alma Vasquez, and Emory Wilson.
Photographs for the third edition were taken by Amy Sullivan, Francis Julian Montgomery, Susan Mayfield‐Johnson, and Darouny Somsanith. Both Amy and Francis Julian are graduates of the CCSF CHW Certificate Program.
Many of the graphics for the new edition were designed by Blanca Goodman, a CHW and visual designer.
We thank the organizations and professionals who contributed Case Studies highlighting better practice standards: Dr. Marilyn Jones of Because Black is Still Beautiful; Sandy Singh with HOPE SF; Morgan Gliedman with the Transitions Clinic Project; Gayle Tang with City College of San Francisco’s Health Care Interpreter Program; Cristy Dieterich with the San Francisco Department of Public Health; Ashley Kissinger with the California Department of Public health; Susan Mayfield‐Johnson with the University of Southern Mississippi; Mattie Clark with the G.A. Carmichael Family Health Center; Michelle James of Friendship House; and Randi Tanksley with the Homeless Prenatal Project.
The educational videos linked throughout the book were codirected by Tim Berthold and Jill Tregor. Matt Luotto and Amy Hill served as videographers. The digital stories featured in Chapters 1 and 15 were produced by the Center for Digital Storytelling (with the leadership of Amy Hill and Matt Luotto).
We are grateful to the members of the C3 and C1 teams who consulted with the editors of the Foundations book and helped ensure that the content was reflective of emerging national standards for the CHW profession. Thank you to J. Nell Brownstein, Durrell Fox, Lily K. Lee, Floribella Martinez‐Redondo, Paige Menking, E. Lee Rosenthal, and Julie St‐John.
Pamela DeCarlo, Terri Massin, and Mike Kometani supported the development of the Foundations textbook by interviewing CHWs to develop profiles, by writing the Case Studies that appear throughout the book, and by reviewing early drafts of chapters.
We acknowledge and thank the faculty who have taught in the CCSF CHW Certificate Program and collaborated with students and community‐based organizations to develop the curriculum that informs this book. We also thank the thousands of CCSF CHW graduates who are working with communities to promote health equity. We are grateful for the lessons you have taught us that inform the content and approach of the Foundations book.
We dedicate this book to community health workers: past, present, and future. We also dedicate this book to our beloved colleague and author, Lorena Carmona, who passed away just a few months before its publication. Lorena was a gifted and dedicated CHW leader. She will be missed and remembered by everyone who knew her.
Contributors
Cristina Arellano, CHW, BA. Cristina is a Case Manager at LifeLong Medical Care in Oakland, California. She has served as a trainer and mentor for the Monterey County CHW Training Project.
Tim Berthold, MPH. Tim Berthold has worked closely with community health workers for over 35 years. He supervised CHWs in public health settings in the United States and internationally. Tim develops and facilitates CHW trainings as part of a consulting group. He previously served as a faculty member and program coordinator for the CHW certificate program at City College of San Francisco.
J. Nell Brownstein, PhD. During Nell Brownstein’s 26 years at CDC, she focused on increasing recognition of the valuable roles played by CHWs as members of the public health workforce and health care teams, especially in diverse communities. She did this through CHW research and evaluation projects, written policy and scientific papers, educational products, and closely working with the CHW Special Interest Group of APHA and many other CHW allies.
Joe Calderon, AS, CHW. Joe Calderon is dedicated to working with diverse and marginalized communities. He spent a decade leading the training and mentoring of Community Health Workers (CHWs) for the Transitions Clinic Network on a national scale. Joe continues to contribute to CHW training through the Foundations for Community Health Workers Consulting Group. Currently serving as a Program Manager at Urban Alchemy, he oversees and trains Employee Care Coordinators (CHWs) for the REAP (Reentry Employment and Prosperity) program. In this role, Joe supports individuals reentering society from state prisons, addressing the complex challenges of reentry and the collateral consequences of incarceration.
Lorena Carmona, BA, CHW. Lorena Carmona is a Community Health Worker and Program Manager with Alameda County Care Connect at Roots Community Health Center in Oakland. Lorena trains and supervises CHWs and provides case management, health education, chronic condition management, and advocacy services. She serves on the Community Advisory Board for the CCSF CHW Certificate Program.
Mattie Clark, CHW. Mattie Clark is a Clinical Community Health Worker with the G. A. Carmichael Family Health Center (FQHC). She has conducted many trainings and events for the community addressing health issues such as hypertension, diabetes, and COVID‐19 and is a co‐author of a study on cardiovascular disease among African Americans. Mattie is a member of the National Association of CHWs and Secretary of the Mississippi Community Health Workers Association.
Pau I. Crego, MPH. Pau I. Crego is an advocate, educator, and author with a passion for advancing equity for transgender, LGBTQI+ and immigrant communities. Over the past two decades, his social justice work has spanned direct services, training and education, program design and implementation, as well as policy research and analysis. Most recently, Pau served as the Executive Director of the San Francisco Office of Transgender Initiatives. He is also part‐time faculty in the CHW certificate program at City College of San Francisco, and a published author and translator in the fields of public health and trans equity.
James Figueiredo, Ed.M. James Figueiredo is grateful for joining and remaining in the CHW field since 1991, when he served as an HIV outreach worker and case manager for over a decade on an integrated clinical team at the Cambridge Health Alliance. He later served as a longtime CHW supervisor and training facilitator across the United States and throughout sub‐Saharan Africa. James is the CEO and Founder of Community Workforce Institute, where he leads a diverse team of trainers and CHW allies dedicated to supporting CHWs and supervisors.
Amie Fishman, MPH. Amie Fishman has worked at the intersections of public health, education, and antiracist organizing for over 25 years. Much of her work has been in support of people affected by incarceration, including training CHWs to assist clients returning home. Amie currently works as a director of equity and culture for the San Francisco Department of Public Health.
Marilyn Gardner, RN, BS. Marilyn Gardner is a writer and public health nurse living in Boston, Massachusetts. Her work with CHWs and CHW supervisors began internationally and has included four countries and several states. She is passionate about working alongside CHWs and CHW supervisors to find creative solutions for community resources and care. Marilyn is the Director of Clinical and Cross‐Cultural Training at Community Workforce Institute in Cambridge, MA.
Lisa Renee Holderby‐Fox, AS. Lisa Renee is a proud member of the CHW workforce with over 30 years of experience. She is the Director of CHW Leadership Development and Envision Co‐Director at the Center for Community Health Alignment, Arnold School of Public Health, University of South Carolina. Lisa Renee is a co‐founder of the National Association of Community Health Workers, the New England CHW Coalition, and the Southeast CHW Network.
Pennie Jewell, CHW, AS. Pennie has been a Community Health Worker for over 30 years. She is a member of the Michigan Community Health Worker Alliance, the National Association of Community Health Workers, and a member of the CHW Common Indicators Project Leadership Team.
Rama Ali Kased, EdD. Rama Ali Kased is an Assistant Professor of race and resistance studies at SF State University. She has over 20 years of experience in community organizing and teaching. Her work and research center on social justice, public health, and education equity. She has an extensive background in campaign and leadership development and K‐12 and higher education curriculum development.
Jimmy Ly, MA. Jimmy Ly is a career counselor and instructor at City College of San Francisco (CCSF) with nearly 10 years of counseling experience in the areas of mental health, careers, and academics. In addition to counseling, he teaches a course on job search techniques and leads career workshops for students in various Health Education programs at CCSF including CHW, Healthcare Interpretation, and Addiction and Recovery Counseling.
Thelma Gamboa‐Maldonado, DrPH, MPH. Thelma is a community‐based public health researcher, academician, and practitioner with extensive experience in non‐profit, local, and state governmental public health practice. CHW inclusion and workforce development have been central to Thelma's work both internationally and in California. Thelma is a former Director of the Loma Linda University San Manuel Gateway College CHW (Promotores) Academy and is currently on faculty in the CHW Certificate Program at City College of San Francisco.
Susan Mayfield‐Johnson, PhD, MCHES. Susan Mayfield‐Johnson has been a CHW ally for over 25 years. She is an Associate Professor at The University of Southern Mississippi, a member of the Leadership Team of the Community Health Worker Common Indicators Project, and a founding board member of the National Association of Community Health Workers.
Lily K. Lee, DrPH, MPH. Lily K. Lee is a multicultural and multilingual public health professional with over 20 years of experience in program design and implementation, research and evaluation, and organizational change management. Lily developed strategic approaches to operationalize CHW/P Core Competencies in various settings and the Organizational Readiness Training program for employers familiar with or new to the CHWs/Ps roles and competencies. Lily is the founder of the KTE Strategies consulting firm, which provides Knowledge Transfer and Exchange strategies to public health and healthcare initiatives for greater impact on population health outcomes.
Savita Malik, EdD, MPH. Savita Malik has been at the intersection of public health and education for more than 20 years. She is faculty at San Francisco State University and a co‐founder and current curriculum and faculty developer for the Metro College Success Program.
Floribella Redondo‐Martinez, BS. Floribella Redondo‐Martinez has been working in the scope of a CHW/Promotora for more than 30 years. She is the co‐founder and chief executive officer of the Arizona Community Health Workers Association. Floribella is a co‐founder and board member of the National Association of Community Health Workers, a member of C3 Core Team, CHW Council for Envision, and a Lead Faculty for the CHW Certificate Program at Arizona Western College.
Paige Menking, MPA. Paige Menking is a CHW ally whose over a decade of work in the field has centered around CHW training, supervision, research, and workforce development on local and national levels. She is the principal and founder of Ponderosa Public Health Consulting and lives in Albuquerque, New Mexico. She serves on the board of the National Association of CHWs and as a leader in the APHA CHW section and is on the core team of the CHW Core Consensus (C3) Project.
Francis Julian Montgomery. Francis Julian Montgomery works as a Street Crisis Response Specialist with the San Francisco Homeless Outreach Team (SF HOT). He works with the San Francisco Fire Department Community Paramedics Division, connecting unhoused people to shelter/housing, mental, medical health programs, treatment, resources, and social service support systems. Francis Julian is certified as an Addictions Treatment Counselor and is a graduate of City College of San Francisco Community Health Worker Certificate Program and the Drug and Alcohol Certificate Program.
Alberta Rincón, MPH. Alberta Rincón has served as an advocate, community organizer, change agent, health educator, trainer, and university administrator in the public health field for over 40 years. Since 2005, she has taught core community health worker coursework at City College of San Francisco.
E. Lee Rosenthal, PhD, MPH E. Lee Rosenthal has worked to support the growth and development of the Community Health Worker (CHW) workforce through collaborative research and advocacy with CHWs since the late 1980s. Lee has led the national Community Health Worker Core Consensus (C3) Project team since it began in 2014. Based at Texas Tech University Health Sciences Center El Paso, she teaches public health to medical and dental students. As of 2023, she serves as co‐editor of the Journal of Ambulatory Care Management, which has a focus on CHW practice and research and that emphasizes CHWs roles as authors and reviewers.
Larry Salomon, PhD. Larry Salomon has been teaching in the College of Ethnic Studies at San Francisco State University for nearly 30 years. He teaches courses on social movements and community organizing, racial politics, critical thinking, and even courses focusing on the intersections between race and both sports and comedy. Larry is the author of the book Roots of Justice: Stories of Organizing in Communities of Color.
Darouny Somsanith, MPH. Darouny Somsanith is the coordinator of the Community Health Worker (CHW) Program and a faculty member within the Health Education Department at City College of San Francisco. She started her public health career as a CHW and has over 20 years of experience working on issues of workforce development and supporting the diverse training needs of community health workers.
Julie Ann St. John, DrPH, MPH, MA, CHWI. Julie St. John is a public health practitioner and researcher who has worked with CHWs locally, nationally, and globally for over 20 years. She is a Texas‐certified Community Health Worker Instructor, served on the Texas CHW Advisory Committee for 10 years, a member of the APHA CHW Section Council, and was a founding board member of the Texas Association of Promotores/Community Health Workers. Her research and practice interests include engaging CHWs in community‐based participatory research and community health development approaches; improving health status and quality of life among diverse and rural populations; addressing human trafficking through community capacity building; and equipping future public health professionals through teaching, service, research, and practice.
Jill R. Tregor, MPH. Jill Tregor is an adjunct instructor with the Community Health Worker and Alcohol and Drug Counselor certificate programs at City College of San Francisco. She has many years of experience working with community‐based organizations addressing hate‐motivated violence, women's health, and domestic violence.
About the Companion Website
This book is accompanied by a companion website.
http://www.wiley.com/go/communityhealthworkers3E
The website includes:
Training guides and Video index
IIntroduction
Foundations for Community Health Workers is a resource for training, teaching, and credentialing CHWs. It is inspired by the curriculum for the CHW Certificate Program at City College of San Francisco (CCSF). The CCSF program (CCSF CHW Program, 2023) was established in 1992 and is still going strong.
2023 graduates of the CCSF CHW Program.
Guiding principles that inform this book include a commitment to health equity and social justice, cultural humility, and person‐ and community‐centered practice that respects the experience, wisdom, and autonomy of CHWs and the communities they serve.
The book is designed for CHWs in training and is divided into five sections:
Part One
provides information about the broad context that informs the work of CHWs. It includes an introduction to the role and history of CHWs, the discipline of public health, and the principles of health equity.
Part Two
addresses the core competencies or skills that most CHWs rely on day‐to‐day. This section includes chapters on ethics, person‐centered practice, cultural humility, motivational interviewing, case management, action planning, and home visiting.
Part Three
addresses key professional skills for career success including stress management, conflict resolution, code switching, providing and receiving constructive feedback, and how to develop a resume and interview for a job.
Part Four
applies key competencies to specific health topics including working with people who are returning home from incarceration, supporting clients with the management of chronic health conditions, healthy eating and active living, and supporting survivors of trauma.
Part Five
addresses competencies that CHWs use when working at the group and community levels, including health outreach, facilitating trainings and groups, research and evaluation skills, and community organizing and advocacy.
One book cannot possibly address all the knowledge and skills required of CHWs. Our intention is to provide an introduction to the competencies most commonly required when working with clients and communities. This textbook does not attempt to provide information about all the specific health issues that CHWs will address in the field (such as type two diabetes, pediatric asthma, substance use, depression and other mental health conditions, and the challenges of being unhoused). Health knowledge changes rapidly as new research findings are released, and many reputable health organizations provide regularly updated information online. Our approach is to cover the key skills that CHWs provide in the field and to let employers take the lead in providing additional training on specific health topics and issues that they will address on the job.
The Community Health Worker Core Consensus (C3) Project (The C3 Project, 2023) has partnered with the Foundations textbook in its third edition to help readers understand how the skills that are featured within each textbook chapter map to the skills identified by the C3 Project.
Why the C3 Project?
The C3 Project (2014–2018) built and now works to maintain a national consensus about CHW core roles and competencies (qualities and skills). The Project’s goal is to expand cohesion in the CHW field and contribute to the visibility and greater understanding of the full potential of CHWs to improve health, community development, and access to systems of care.
The C3 Project findings reflect a consensus‐driven process that emphasized the input of CHW leaders working at the local, state, and national levels about CHW roles and competencies. CHW guidance was prioritized as a first step before Project findings were released to a wider national audience. The C3 Project team believes it is the Project’s commitment to CHW participation and oversight that has fostered the wide use and support of the C3 Project core roles and competencies.
The C3 Project core roles and competencies originated from a national study in the 1990s led by the same leadership team. In order to carry out the C3 Project, the research team used the 1994–1998 National Community Health Advisor Study (NCHAS) recommended core roles and competencies as a baseline and compared them to emerging CHW roles and competencies identified in selected policy and training sources—including
just one curriculum—the Foundations textbook itself
. The focus of the C3 Project comparison, or “crosswalk” as it is known, was to identify what new roles and skills had emerged (or disappeared) in the two decades since the original NCHAS.
From that research and supporting consensus‐driven review, the C3 Project identified:
CHW roles or scope of practice:
Ten (10) core roles that CHWs play; together these roles form the CHW “scope of practice.” The
Foundations
textbook is intended to build CHW’s capacity to play these many roles in service to individuals, families, and communities.
CHW qualities
: Qualities are the natural and nurtured inner passion and motivation that CHWs possess—a core element of qualities is CHWs’ connection to the community served. The C3 Project endorsed qualities identified in the NCHAS that were reaffirmed in consensus‐driven work in New York. In the future, the C3 Project will assess these qualities more fully.
CHW skills
: Eleven (11) core skills range from communication to capacity‐building skills. These eleven (11) skills combined give CHWs a strong foundation for their work and service.
The following table shows where each of the C3 Project’s Core CHW Skills is covered in the Foundations book.
ALIGNING THE C3 PROJECT AND THE
FOUNDATIONS FOR CHWs
TEXTBOOK
C3 CHW COMPETENCIES: CORE SKILLS
FOUNDATIONS
CHAPTER(S)
Communication Skills
Chapters 6
,
7
,
9
,
13
,
20
, and
21
Interpersonal and Relationship‐building Skills
Chapters 5
,
6
,
7
,
9
,
13
, and
18
Service Coordination and Navigation Skills
Chapters 8
,
10
,
11
,
16
,
17
, and
18
Capacity‐building Skills
Chapters 1
,
9
,
15
,
21
,
22
, and
23
Advocacy Skills
Chapters 2
,
4
,
10
, and
23
Education and Facilitation Skills
Chapters 19
,
20
, and
21
Individual and Community Assessment Skills
Chapters 3
,
8
,
9
,
11
,
16
,
17
,
22
, and
23
Outreach Skills
Chapters 19
and
23
Professional Skills and Conduct
Chapters 5
,
7
,
12
,
13
, and
14
Evaluation and Research Skills
Chapters 2
,
3
, and
22
Knowledge Base
Chapters 1
,
2
,
3
,
4
,
5
,
6
,
15
,
16
,
17
, and
18
Each chapter in the Foundations textbook displays a brief chart at the start to allow you to make a crosswalk to the C3 Project Skills that most align with the content in the Foundation textbook chapter.
In addition to the C3 skills crosswalk in each chapter, to learn more about the C3 Project, see Chapter 1 on the role of CHWs and Chapter 2 on the history of the CHW field. We have included the C3 Project Review Checklist of CHW Roles and Competencies at the end of the book. You can use this resource to assess your progress in learning essential professional skills; you can reach the C3 Project team at: [email protected]
The new edition of Foundations includes 23 Profiles of working CHWs—one in each chapter. Each profile captures the motivations and contributions of a CHW along with their tips and suggestions for those starting out in the profession.
The book includes short educational videos (QR codes are provided in the hard copy edition of the book and direct links in the e‐book version) highlighting key CHW concepts and skills. These videos feature interviews with CHWs and public health experts, as well as role‐plays that show CHWs working with clients. The role plays are designed to demonstrate key CHWs skills. We have also included “counter” role plays that highlight common mistakes or approaches that we wouldn’t recommend for CHWs. We use these videos to generate discussion in our classrooms and to engage students in applying key concepts for working effectively with clients. All videos are posted to the Foundations for CHWs YouTube Channel at https://www.youtube.com/@foundationsforcommunityhea6889/search
Please watch the following two videos that were created by students who graduated from the City College CHW Certificate Program. These are called “digital stories,” and they briefly describe what motivated each video maker to become a CHW.
CHW DIGITAL STORY: ROBERT’S STORY
(Source: Foundations for Community Health Workers/http://youtu.be/Acaf7cKFGy0/last accessed 21 September 2023.)
CHW DIGITAL STORY: LUCIANA’S STORY
(Source: Foundations for Community Health Workers/http://youtu.be/FS9leOmwACk/last accessed 21 September 2023.)
A companion Training Guide to Foundations for Community Health Workers is available for free at Wiley (Wiley, 2023). The Training Guide presents step‐by‐step training plans and assessment resources corresponding to each chapter of the Foundations textbook. Additional educational videos are also provided.
This book is rooted in a deep hope for a world characterized by social justice and equitable access to the basic resources—including education, employment, food, housing, safety, health care, and human rights—that everyone needs in order to be healthy. CHWs play a vital role in helping to create such a world. They partner with clients and communities and support them to take action to bring this hope closer to reality.
Tim Berthold and Darouny Somsanith
Co‐editors
References
City College of San Francisco. (2023). Community Health Worker Certificate Program.
https://www.ccsf.edu/degrees‐certificates/community‐health‐worker
(accessed 6 June 2023).
The Community Health Worker Core Consensus Project (C3). (2023). The Community Health Worker Core Consensus Project (C3).
https://www.c3project.org/
(accessed 6 June 2023).
Wiley. (2023). Foundations for Community Health Workers Training Guide.
https://bcs.wiley.com/he‐bcs/Books?action=index&bcsId=10183&itemId=1119060818
(accessed 6 June 2023).
PART 1COMMUNITY HEALTH WORK: THE BIG PICTURE
1The Role of Community Health Workers—Serving with Skills and Compassion
Darouny Somsanith and Susan Mayfield‐Johnson
Introduction
Welcome to our book! In this first chapter, you will be introduced to the key roles and competencies of Community Health Workers (CHWs) and the common qualities and values shared by successful CHWs.
You may already possess some of the qualities, knowledge, and skills common among CHWs.
Are you a trusted member of your community?
Have you ever assisted a family member or friend to obtain health care services?
Are you passionate about changing the factors that are harming your community’s health?
Have you participated in efforts to advocate for social change?
Do you hope that, in your work, you can work with your community members to become healthy, strong, and in charge of their lives?
If you answered yes to any of these questions, you have some of the qualities and characteristics of a successful CHW.
WHAT YOU WILL LEARN
By studying the information in this chapter, you will be able to:
Describe CHWs and what they do
Identify where CHWs work, the communities they work with, and the health issues they address
Explain the core roles that CHWs play in the fields of public health, healthcare, and social services
Discuss the core competencies that CHWs use to assist individuals and communities
Describe personal qualities and attributes that are common among successful CHWs
Discuss emerging models of healthcare and opportunities for CHWs
Discuss the importance of language access for clients and communities with limited English language skills
C3 Roles and Skills Addressed in Chapter 1
WORDS TO KNOW
Advocate (noun and verb)
Affordable Care Act (ACA)
Core Roles and Competencies
Credentialing, Health Inequities
Mortality, Social Determinants of Health
Scope of Practice
Social Justice
1.1 Who Are CHWS and What Do They Do?
CHWs help individuals, families, groups, and communities to improve their health, increase their access to health and social services, and reduce health inequities. CHWs generally come from the communities they serve and are uniquely prepared to provide culturally and linguistically appropriate services. They work with diverse and often disadvantaged communities at high risk of illness, disability, and death.
CHWs provide a wide range of services, including outreach, home visits, health education, and person‐centered counseling and care management. They support clients in accessing high‐quality health and social services programs. They facilitate support groups and workshops and support communities to organize and advocate (to actively speak up and support a client, community, or policy change) for social change to advance the community’s health and welfare. CHWs also work with public health, healthcare, and social services agencies to enhance their capacity to provide culturally sensitive services that truly respect the diverse identities, strengths, and needs of the clients and communities they serve.
As a result of the contributions of CHWs, clients and communities learn new information and skills, increase their confidence, and enhance their ability to manage health conditions and advocate for themselves. Most importantly, the work that CHWs do reduces persistent health inequities or differences in the rates of illness, disability, and death (mortality) among different communities (Hurtado et al., 2014).
The term community health worker describes both volunteers who contribute informally to improve their community’s health and those who are paid for providing these services. Regardless of compensation, CHWs serve as “frontline” health and social service workers and are often the first contact a community member has with a health or social service agency. Typically, CHWs are trusted members of the community they serve, having deep knowledge of the resources, relationships, and needs of that community.
As helping professionals, CHWs are motivated by compassion and the desire to assist those in need. Their core professional duties are to work for equity and social justice, a belief that all people deserve to be valued equally and provided with equitable access to essential health resources such as housing, food, education, employment, health care, and civil rights. Many CHWs take on this work because they have experienced discrimination and poverty themselves. Others simply see a need and want to improve conditions in their communities. Regardless of how the CHW comes to the work, every CHW is an advocate—someone who speaks up for a cause or policy or on someone else’s behalf—working to promote health and better the conditions that support wellness in local communities.
The American Public Health Association adopted an official definition for CHWs in 2009, developed by CHWs, researchers and advocates:
A Community Health Worker (CHW) is a frontline public health worker who is a trusted member of and/or has an unusually close understanding of the community served. This trusting relationship enables the CHW to serve as a liaison/link/intermediary between health/social services and the community to facilitate access to services and improve the quality and cultural competence of service delivery. A CHW also builds 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.
(American Public Health Association,2009).
In 2010, U.S. Department of Labor, Bureau of Labor Statistics, approved a standard occupational code—SOC 21‐1094—and further defined CHWs as professionals who:
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 aid and blood pressure screening. May collect data to help identify community health needs.
(Bureau of Labor Statistics, 2023).
Having a standard occupational code allowed for CHW positions to be reported as part of employment statistics. Prior to this, CHWs were included in the broad category of “social and human service assistants,” which undercounted their total numbers in the U.S. workforce, as many were not counted at all in official statistics. Complicating this further is the estimated 250 job titles that are associated with the CHW profession, which made it hard to truly capture this classification of worker.
Denise Octavia Smith: How are we unique? At the heart of being a CHW—and I know a lot of CHWs that did not work with this title for many years or maybe even decades doing this work—what has always set us (CHWs) apart is this sort of Venn diagram of our lived experience, our commitment to community well‐being, both individual and the larger community of families, and ecosystems that sort of supported this burden. I would say we build both the capacity for people to find what they need to achieve health and well‐being, and we advocate to change those things that prevent health and well‐being. Right? It's like when these things all come together, you would call it a community health worker.
You may know a CHW already. You might be one. Health departments, community‐based organizations, hospitals and clinics, faith‐based organizations, foundations, and researchers value the important contributions of CHWs to promoting the health and well‐being of low‐income and at‐risk communities. CHWs work under a wide range of professional titles. Some of the most popular are listed in Table 1.1.
Table 1.1 Common Titles for CHWs
Case manager/Case worker Community health advocate Community health outreach worker Community health worker Community health representative Community outreach worker Community liaison Community organizer Enrollment specialist
Health ambassador Health educator Health worker Lay health advisor Public health aide Patient navigator Peer counselor Peer educator Promotor/a
de salud
Can you think of other titles for CHWs?
A team of CHWs planning their work
Please watch this video interview about Becoming a CHW.
(Source: Foundations for Community Health Workers/http://youtu.be/BASkvuq1epw)
Lisa Renee Holderby‐Fox: My first job as a CHW was doing home visiting with high‐risk pregnant women and teens. I was living in an area of Massachusetts that had the highest infant mortality rate for Black women and Latinas. They were looking to hire individuals who had common experiences. I had been a teen parent and had needed the same services as many of those I’d be working with. Many times, I did not know what was out there or what was available for additional support. It was a lot of trial and error for me. I thought that if I could help someone else and help them get the services and support they needed, it would be a really interesting job. I applied and was hired.
The first person I worked with was referred by her primary care provider. She was diabetic and pregnant, and he (the provider) called her “noncompliant.” He said that she wasn’t eating well; she wasn’t taking her insulin the way she should take it, and that put her at higher risk during pregnancy and delivery. That’s why he referred her to our program.
She was in the hospital because of her diabetes when I met her. She had a really tough exterior, but I don’t know, there was something interesting about her. I wanted to get to know more, get to know her a little better, and maybe I could offer some assistance. When I did my first home visit, she had no electricity. Without electricity, she couldn’t keep food in the fridge or store her insulin. I was able to get her electricity back on, and we got a second‐hand fridge from a local agency (they just gave it to us).
Over time, I saw that she was taking her insulin, eating better, and had a successful delivery. After giving birth, she disclosed partner abuse. I knew I could not tell her to leave because that is not what women want to hear in that moment. That’s not what I wanted to hear when I was in an abusive relationship, so I just worked with her over time, gave her resources, and let her know gradually that there was something better for her out there, that she deserved more, and she finally left him. She was a great mom, and I was able to see all of that happen. That’s when I knew I had a purpose and a place in this work. As I got to work with more women who had a variety of different needs, it just became apparent to me that I had something to give.
It has been difficult to determine how many CHWs are working in the United States due to the wide variety of CHW job titles and duties. In the last 15 years, several national studies have attempted to take inventory of CHWs, most notably the 2007 study by the U.S. Department of Health and Human Services and the University of Texas in San Antonio (USDHHS, 2007) and the two National Community Health Worker Advocacy Surveys (Arizona Prevention Research Center, 2014
