New Mexico Community Health Workers' Place

One of the things i love about CHWs is that they're not easy to define -- which means they're real! After all, think of any single person who fits a "definition." Pretty stereotypical, ey? And mostly found in novels... But, alas, the people who pay for health services aren't so enamored of difficult-to-define workers. To that end, we've been working on a definition of CHWs for New Mexico. This definition serves several purposes. First, it gives us something with which to approach third-party payors, legislators, and anyone else with purse strings. Second, it provides a framework for developing core competencies and training program. Before a training program can be developed, there needs to be a somewhat clear idea of what CHWs are expected to do. Third, it gives CHWs themselves a framework and identity. That's helpful, especially when your friends start asking "So what is it you do, anyway???"

At any rate, here's the current definition of CHWs that has been adopted by the New Mexico CHW Advisory Council and has been used as the foundation for developing recommendations and guidelines for certifying and standardizing training of CHWs in New Mexico.

Note: CHW is used here as an umbrella term and includes those who work under an array of job titles, including promotor(a), outreach worker, community health advocate, peer health educator, and others. Community Health Representatives (CHRs), who are trained and work under the auspices of Tribal CHR programs, are also included in the umbrella term.

• The CHW is an integral member of the health-care team who brings a distinct and necessary set of skills to that team.
• CHWs are community members who face the same barriers as do others in the community.
• CHWs help other community members improve health status by:
• acting as a liaison between community members and health and social services systems;
• providing culturally-responsive education about health issues;
• extending the provision of health-care services;
• helping community members prevent and manage chronic diseases;
• creating opportunities for community members to come together to address health issues; and
• modeling healthful behaviors.

 Compare this to another definition, presented in the HRSA CHW National Workforce study (published March 2007

 Community health workers are lay members of communities who work eitherfor pay or as volunteers in association with the local health care system in both urban and rural environments and usually share ethnicity, language, socioeconomic status and life experiences with the community members they serve. They have been identified by many titles such as community health advisors, lay health advocates, “promotores(as),”1 outreach educators, community health representatives, peer health promoters, and peer health educators. CHWs offer interpretation and translation services, provide culturally appropriate health education and information, assist people in receiving the care they need, give informal counseling and guidance on health behaviors, advocate for individual and community health needs, and provide some direct services such as first aid and blood pressure screening.

There are a few things that give me heartburn about this definition. First, the use of the word "lay" always bugs me -- i understand that they're trying to differentiate between licensed providers and CHWs, but there's something about the "lay" that seems to imply that they're somehow lesser, or not on the same plane (or maybe that's my Catholic upbringing talking!). Second, what about social services systems? Most of the CHWs i know need to know a lot about things like food stamps, emergency shelters, and other community resources.  Third, the list of "what do you do" seems somewhat limiting and at times too vague ("assist people in receiving the care they need") and at times too specific ("provide some direct services such as first aid and blood pressure screening.").

i'll admit that i'm biased, since i developed the first definition myself and was pleased when the Council adopted it with only a few tweaks. But i'm still disturbed by the HRSA findings. The profile of the CHWs in the study also disturbed me. Nearly one-third of employers they surveyed required CHWs to have bachelor's degrees; 39% of the CHWs surveyed were Anglo; and starting wages were about $13/hour. That's not what we found in New Mexico, where a high school diploma was required by most employers, less than 10% of the CHWs surveyed were Anglo, and average wages, including experienced CHWs in supervisory positions, were $7.10.

Why is that important? It's important because there's a move afoot to certify CHWs on a national level. And if certification and training requirements reflect the definition and profile of CHWs in the HRSA study, New Mexico's CHWs are going to have trouble fitting that profile. That makes it all the more important that New Mexico develop a CHW definition, certification process, and training guidelines that fit the needs of CHWs in the state.

 Thoughts? 

--renee  

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