Community Health Workers Leading the Charge on Workforce Development: Lessons from New Orleans

Abstract

Academic institutions and community organizations engaged community health workers (CHWs) in creating a community-appropriate CHW workforce capacity-building program in an area without a previously established CHW professional group. From 2009 to 2010, we solicited New Orleans-based CHWs’ opinions about CHW professional development through a survey, a community conference, and workgroup meetings. Throughout 2011 and 2012, we created and implemented a responsive 80-h workforce development program that used popular education techniques. We interviewed CHWs 6 months post-training to assess impressions of the course and application of skills and knowledge to practice. CHWs requested training to develop nationally-recognized core competencies including community advocacy, addresses issues unique to New Orleans, and mitigate common professional challenges. Thirty-five people completed the course. Among 25 interviewees, common themes included positive impressions of the course, application of skills and community-specific information to practice, understanding of CHWs’ historical roles as community advocates, and ongoing professional challenges. Engaging CHW participation in workforce development programs is possible in areas lacking organized CHW groups. CHW insight supports development of training that addresses unique local concerns. Trained CHWs require ongoing professional support.

Appendix: Louisiana Community Health Worker Institute Core-Competency Curriculum Overview

Module Topics covered	Competency or area addressed 1 = CHW role 2 = Communication skills 3 = Interpersonal skills 4 = Teaching skills 5 = Capacity-building skills 6 = Organizational skills 7 = Service coordination skills 8 = Advocacy skills 9 = Issues unique to local context 10 = Professional challenges
1. CHW definition, role and history CHW definition, alternative names, roles, core competencies, and timeline of significant events	1
2. Introduction to public health Public health overview and agencies, top 10 causes of death, ecological model, and social determinants of health	1, 7, 8
3. Health disparities and health promotion Health disparities, upstream versus downstream approaches, programs versus policies, and policies to promote health equity	1, 8
4. Introduction to U.S. health care system Health care systems, costs, and payers; CHWs and the Affordable Care Act	1, 7
5. Defining and developing leadership skills Leadership definition, behaviors, and skills; developing CHW leadership	1, 8
6. Cultural humility Culture, stereotypes, race, and ethnicity; collecting data on race and ethnicity; self-reflection; strategies and cautions for practicing cultural humility; and cultural health beliefs	2, 3, 8
7. Communication skills Clients with limited English proficiency, verbal and non-verbal communication, open-ended questions, and active listening	2, 3, 9
8. Working with individuals Ethics, scope of practice, boundaries, confidentiality, and mandatory reporting	1, 2, 3, 4, 5
9. Behavior change Stages of change, client-centered counseling, setting goals, and harm reduction	2, 3, 4, 5, 6, 7
10. Client interviewing Motivational interviewing techniques, home visiting, and safety	2– 5, 7
11. Case management Creating a plan, documentation, referrals, and client advocacy	2, 3, 5, 7
12. Working in teams and strategies for resolving conflict Destructive versus constructive conflict, common sources of conflict, communication skills for addressing conflict, and conflict styles	1, 2, 3, 10
13. Professional skills and stress management Resume writing, interviewing skills, common sources of and responses to stress, signs of burnout, resources for stress management, self-care assessment, and self-care planning	2, 3, 6, 10
14. Practicing in the post-Katrina context Restructuring of the local health care system, signs and symptoms of common mental disorders, talking about mental health and establishing trust, overcoming stigma, behavioral activation	2, 3, 9, 10
15. Teaching and group facilitation skills Sources of accurate health information, learning styles, preparing to teach, assessment, addressing challenges in group facilitation	3–6
16. Community resources and outreach Community health resources; outreach definition, methods, preparation, conduct, and documentation	5, 6, 7, 9
17. Community assessment Planning a community assessment, needs- versus assets-based assessments, sources of qualitative and quantitative data	6, 8, 9
18. Advocacy part 1: advocacy steps Connection between policy and health; advocacy definition, steps, and planning	1, 5, 8
19. Advocacy part 2: communicating with policymakers Ways to reach lawmakers; letter writing and phone call campaigns; scheduling, preparing for and conducting a legislative visit; scope of local government	1, 2, 3, 4, 5, 6, 8
20. Final presentations Students present: how to address a public health issue at an individual, community, and policy level	1–10