History of Community Health Workers in America
Please scroll though our Community Health Workers Over the Years interactive timeline to learn about the history of community health workers in America and recent developments within the field.
You can also find the text below.
In recent years, Community Health Workers have been gaining national recognition for their ability to effectively address health and social issues within their communities. Several organizations have supported the increased involvement of Community Health Workers in health and human services and the advancement of the Community Health Worker profession.
1970/2000– American Public Health Association (APHA)
Since the 1970s,Community Health Workers have been a rallying voice within the American Public Health Association (APHA). A Community Health Worker-led section was initially created within APHA called the New Professionals Special Primary Interest Group (SPIG). In 2000, the group changed its name to the Community Health Worker Section and continues to “to promote the community’s voice within the health care system.” (1)
The Community Health Worker Section adopted the following definition for a Community Health Worker:
A Community Health Worker 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 Community Health Worker 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 Community Health Worker 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.
June 1998– National Community Health Advisor Study
Completed in 1998, the National Community Health Advisor Study helped identify core roles, competencies, and qualities of Community Health Workers. (2)
March 2007– HRSA National Workforce Study
In 2007, the Health Resources and Services Administration provided a comprehensive, national report on the Community Health Worker workforce. (3)
2010– Bureau of Labor Statistics
Another milestone in the history of Community Health Worker professional identity was in 2010 when the Bureau of Labor Statistics assigned an occupational code to Community Health Workers: (4)
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. Excludes “Health Educators” (21-1091).
March 23, 2010– Patient Protection and Affordable Care Act
As health care in the U.S. enters an era of pivotal change, Community Health Workers have been identified as an important component in the “health care workforce”. Community Health Workers are cited in three sections of the Patient Protection and Affordable Care Act (PPACA): (5)
§5101 – Community Health Workers are listed as members of the “health care workforce” and are defined as health professionals
§5313 – The PPACA authorizes the Centers for Disease Control and Prevention to fund agencies who train health care team members, including CHWs, and to direct intervention grants “to eligible entities to promote positive health behaviors and outcomes for populations in medically underserved communities through the use of community health workers.”
§5403 – Area Health Education Centers will be funded to “conduct and participate in interdisciplinary training that involves physicians, physician assistants, nurse practitioners, nurse midwives, dentists, psychologists, pharmacists, optometrists, community health workers, public and allied health professionals, or other health professionals, as practicable.”
The Patient Protection and Affordable Care Act of 2010 (PPACA) specifically cites the use of Community Health Workers as an effective way of improving health outcomes as part of a health care team while containing costs. (6) The law lists “community health worker” as a member of the health care workforce and as a health professional (7); the law also authorizes the Centers for Disease Control and Prevention to fund agencies who train health care team members, including Community Health Workers, and to direct intervention grants “to eligible entities to promote positive health behaviors and outcomes for populations in medically underserved communities through the use of community health workers.” (8)
July 15, 2013– Centers for Medicare and Medicaid Services
The Centers for Medicare and Medicaid Services (CMS) created a new rule which allows state Medicaid agencies to reimburse for preventive services provided by professionals that may fall outside of a state’s clinical licensure system, as long as the services have been initially recommended by a physician or other licensed practitioner. The new rule for the first time offers state Medicaid agencies the option to reimburse for more community-based preventive services, including those of Community Health Workers. The rule goes into effect on January 1, 2014. (9) (10)
The new rule now states,
“(c) Preventive services means services recommended by a physician or other licensed practitioner of the healing arts acting within the scope of authorized practice under State law to—
- Prevent disease, disability, and other health conditions or their progression;
- Prolong life; and
- Promote physical and mental health and efficiency.”
State Initiatives around Community Health Workers
A number of states have taken to diverse, individual initiatives to advance the Community Health Worker infrastructure, professional identity, workforce development, and financing: (11)
- 15 states and the District of Columbia have enacted laws addressing Community Health Worker infrastructure, professional identity, workforce development, or financing
- 6 states have created Community Health Worker advisory boards
- 8 states have established a Community Health Worker scope of practice
- 5 states have enacted workforce development laws that create a certification process or require Community Health Workers to be certified
- 6 states have authorized the creation of standardized curricula
- 4 states have authorized a certification board for setting education requirements and governance for certification process
- 7 states have authorized Medicaid reimbursement for some Community Health Worker services
- 7 states have encourages or required the integration of Community Health Workers into team-based care models
- (1) American Public Health Association Community Health Worker Section, 2009, http://www.apha.org/membergroups/sections/aphasections/chw/
- (2) http://crh.arizona.edu/sites/crh.arizona.edu/files/pdf/publications/CAHsummaryALL.pdf
- (3) Community Health Worker National Workforce Study, March 2007
- (4) Bureau of Labor and Statistics Standard Occupational Classification: 21-1094 Community Health Workers
- (5) MiCHWA Patient Protection & Affordable Care Act of 2010
- (6) Patient Protection and Affordable Care Act, 42 USCA §18001 (2010).
- (7) Patient Protection and Affordable Care Act, 42 USCA §294q (2010).
- (8) Patient Protection and Affordable Care Act, 42 USCA §280g-11 (2010).
- (9) Medicaid and children’s health insurance programs: essential health benefits in alternative benefit plans, eligibility notices, fair hearing and appeal processes, premiums and cost sharing, exchanges: eligibility and enrollment; final rule. Centers for Medicare & Medicaid Services. 78 Fed Reg 42160 (July 15, 2013). The relevant section is, “a. Diagnostic, Screening, Preventive, and Rehabilitative Services (Preventive Services) (§ 440.130)” (paragraph citation: 78 FR 42226)
- (10) NHLBI CHW Health Disparities Initiative Email August 28, 2013
- (11) Centers for Disease Control and Prevention, “A Summary of State Community Health Worker Laws”
- (12) MiCHWA Lessons from Other States