TABLE 2
Proposed framework of CHW functions and practice with supportive citations
Category I:
Peer Community Health Worker (PCHW)
Category II:
General Community Health Worker (GCHW)
Category III:
Clinical Community Health Worker (CCHW)
Category IV:
Health Navigator (HN) 4A-Qualifications
Shares conditions, demographics, or experience with targeted population.1,2,3
Shares conditions, demographics, or experience with targeted population.
3,4,5,6,7
May not share conditions, demographics, or experience with targeted population.
May have keen interest or specific background working with the population.8
Usually does not share condition, demographic, or experience with targeted population.8,9,10
No minimum education required.11,12 Most programs require high school completion or GED.1,6,13
Most programs require high school or GED; many have required post-secondary education.13
Require a clinical background such as nurse, social worker, health navigator or health educator with minimum associate degree.9,10,13,14
Supervised by an institution-based program supervisor or by a medical director or designee.13 Community-based organizations usually answer to
community advisory group.15
Supervised by Community-based organization.1,13,16
Supervised by a degreed professional within the medical
system.1,2,6,7,9,10,15,,17,18,,19,,21,22,23
Frequently functions as a supervisor for other CHW’s.24,25,26
Supervised by a degreed professional within the medical system.2,13,17,18,19,20,27
4B- Functions (Behaviors/Interventions, Demonstrated Competencies) Health System Navigation: Assists with
system navigation and community resource connection.2,7,11
Assists with system navigation and community resource
connection.4,5,7,15,17,19,23
Provides system navigation and community resource connection.
Enhances access to system resources.
Provides care coordination services but not case
management.1,2,3,4,5,6,7,9,12,15,17,19,21,23,,26,27, 28,29,30
Provides system navigation and community resource connection.
Enhances access to system resources.
Provides care coordination services and/or case management.9,10
Health Education: Assists with education regarding specific disease or medical condition.6,11,12,22,26,31
Conducts culturally competent education with direction and/or
supervision.2,3,4,5,6,10,11,12,15,17,19,21,22,26,28, 29,30,31,32
May assist with the development of education. Conducts culturally competent education with direction and/or supervision.2,3,4,5,6,10,11,12,15 17,19,21,22,26,28,29,30,31,32
May develop and/or, conduct education;
may supervise or assist CHWs conducting classes.
Advocacy: May advocate for individual May advocate for individual patient or be May advocate for individual patient or be May advocate for individual patient or be
patient or be involved in general awareness regarding specific disease or medical condition.11
involved in general awareness regarding specific disease or medical
condition.3,4,6,11,27
Advocates for populations based on identified needs.3,4,6,11,27,28,29,30
involved in general awareness regarding specific disease or medical condition but may be limited by employment
situation.3,4,11,,29,30,33,34
involved in general awareness regarding specific disease or medical condition but may be limited by employment situation.
Emotional Support: Provides coaching and social
support.2,5,6,7,9,11,12,15,17,19,21,23,27,29,30,31,32,
Provides coaching and social support.2,5,6,7,9,11,12,15,17,19,21,23,27,29,30,31,32
Provides coaching and social support by serving as a link between the medical institutions and
ommunity.2,5,6,7,9,11,12,17,19,21,23,27,28,29,30,31,32
Provides coaching and social support.
Serves as a liaison between the academic centers and community.
Provides emotional support and
counseling within the scope of practice as defined by the credential.
Direct Service: Provides direct service within organizational or project guidelines.4,6,10,11,12,13,29,30
Provides direct service within the CHW scope of practice.4,6,10,11,12,13,,29,30
Provides direct service as delegated by the medical team.4,6,10,11,12,13,29,30
Provides direct service as outlined by the scope of practice determined by the credential.9,10
Outreach and Case-finding: Conducts outreach and case-finding for specific population.6,35,36
Conducts outreach and case-finding for general populations.2,3,6,9,11,23,26,27,35
Conducts outreach and case-finding for general populations.2,3,6,9,11,23,26,27,35,37
Participates in formal activities related to recruitment of patients into clinical services.38
Designs and plans outreach activities.
Conducts outreach and case-finding for general populations
Participates in formal activities related to recruitment of patients into clinical services.
Evaluation and Research: May assist with community assessments and/or gather patient data.1,4,10,11,12,20,22,26,27,29
Participates in evaluation and research.
May assist with community assessments and gather patient data.1,4,10,11,12,20,22,26,27,29
Participates in evaluation and research, assists with community assessments and gathers patient data.10,11,12,20,22,26,29
Participates in evaluation and research activities. Assists with community assessments. Gathers patient data.
Contributes to evaluation and research plans and activities.
May lead in the implementation of evaluation and research plans.
4C-Other Characteristics Usually carries out specific tasks which
may or may not be part of a medical treatment plan.25,33,34,39
Can either be part of a medical care team or functions independently using a client-centered approach.25,33,34,39
Gives limited medical advice, involved in medical care planning using client- centered approach and supports existing treatment plans developed by the medical team.25,33,39
Provides medical advice within the scope of practice as defined by the credential held. Uses person-centered approach.
Hired by community-based organization or medical institutions or may be
Hired by community-based organizations or medical institution or may be
Usually hired by a health system either private or governmental. Use of
Hired by a health system either private or governmental.14
volunteers.8 volunteers.8 volunteers occurs but is not common.2,8,38 Can maintain a caseload of patients,
work one-on-one and/or be population based.8
.Can maintain a caseload of patients, work one-on-one and/or be population based.8
Usually carries a specific caseload number over time with end goals established.8
Long-term client retention varies depending upon circumstances and program.37
Usually carries a specific caseload number over time with end goals established.
Long-term client retention varies and depends on the needs of the patient, the institution and established protocols.
Initial trust and credibility are strong.
Uses shared experience to develop working relationship.38,,41,42,43
Initial trust and credibility good are good.38 Uses shared cultural and background experiences to develop working relationship.13,40,41
Developing trust must be earned by the provider.8
Using learned strategies to earn trust in a patient/provider relationship are critical to success.
Introductory education on roles, responsibilities, and services are needed along with information on the specific disease/condition shared with the client.37,40,41,44
Formal training and experience are diverse and not standardized nationally.
Introductory education on roles, responsibilities and services along with information about the specific diseases or conditions of the target population.
37,40,41,44
Most clinical CCHWs have a mix of formal training and on-the-job experiences based upon the resources of the institution.6,44 Strategies to earn trust be learned and included in trainings. Most trainings are developed by the institution or local organizations. Knowledge of the medical care system, CHW roles, social determinants of health, and community assessments, chronic diseases and other population specific conditions are needed.37,40,41
All health navigators have formal training in medical or human services.14
Knowledge of the medical care system may be high, but knowledge of the community health workers role may be limited.
Knowledge of social determinants of health and community may be high but variable. Continuing education is expected, and educational needs may be high.
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