Journal of Public Health Policy

, Volume 39, Issue 2, pp 203–216 | Cite as

Extension for Community Healthcare Outcomes (ECHO): a new model for community health worker training and support

  • Miriam Komaromy
  • Venice Ceballos
  • Andrea Zurawski
  • Thomas BodenheimerEmail author
  • David H. Thom
  • Sanjeev Arora
Original Article


More than 50,000 community health workers (CHWs) are employed in the United States (US), a country with no national accreditation or certification program. In the US, CHWs are trained, formally and/or on-the-job, and rarely is long-term mentoring included. We developed a CHW training program using the Extension for Community Healthcare Outcomes (ECHO) model™, distance education using video teleconferencing to support case-based learning, and mentoring of healthcare providers from medically underserved communities. We describe the ECHO model for CHW training and mentoring using case examples and pre/post-surveys from our obesity prevention and addiction recovery programs. Using the ECHO model to train and support CHWs offers advantages over traditional training methods, and can be adapted in other countries to support CHWs to improve health in their communities.


Community health worker ECHO model Distance education Obesity prevention Addiction recovery 


  1. 1.
    Perry HB, Zulliger R, Rogers MM. Community health workers in low-, middle-, and high-income countries: an overview of their history, recent evolution, and current effectiveness. Annu Rev Public Health. 2014;35:399–421.CrossRefGoogle Scholar
  2. 2.
    American Public Health Association. Community Health Workers. 2017. Accessed 15 Jan 2017.
  3. 3.
    Perry HB, Crigler L, editors. Developing and strengthening community health worker programs at scale. United States Agency for International Development (USAID). Washington, DC. 2014: Accessed 22 Oct 2017.
  4. 4.
    Kangovi S, Grande D, Trinh-Shevrin C. From rhetoric to reality—community health workers in post-reform U.S. health care. N Engl J Med. 2015;372:2277–9.CrossRefGoogle Scholar
  5. 5.
    Wadge H, Bhatti Y, Carter A, Harris M, Parston G, Darzi A. Brazil’s family health strategy: using community health care workers to provide primary care. New York, NY: The Commonwealth Fund. 2016.
  6. 6.
    Albritton E. Health equity and health system transformation: how states can fund community health workers through Medicaid to improve people’s health, decrease costs, and reduce disparities. Families ISA: Washington DC. Issue brief: HE-HST071116. 2016. Accessed 20 Oct 2017.
  7. 7.
    Association of State and Territorial Health Officials. Community health workers (CHWs) training/certification standards. 2017. Accessed 15 Jan 2017.
  8. 8.
    McElmurry B, McCreary L, Park C, Ramos L, Martinez E, Parikh R, et al. Implementation, outcomes, and lessons learned from a collaborative primary health care program to improve diabetes care among urban Latino populations. Health Promot Pract. 2009;10(2):293–302.CrossRefGoogle Scholar
  9. 9.
    Kenya S, Jones J, Arheart K, Kobetz E, Chida N, Baer S, et al. Using community health workers to improve clinical outcomes among people living with HIV: a randomized controlled trial. AIDS Behav. 2013;17(9):2927–34.CrossRefGoogle Scholar
  10. 10.
    Findley SE, Sanchez M, Mejia M, Ferreira R, Rena O, Matos S, et al. Effective strategies for integrating immunization promotion into community programs. Health Promot Pract. 2009;10(2 Suppl):128S–37S.CrossRefGoogle Scholar
  11. 11.
    Viswanathan K, Hansen PM, Rahman MH, Steinhardt L, Edward A, Arwal SH, et al. Can community health workers increase coverage of reproductive health services? J Epidemiol Community Health. 2012;66(10):894–900.CrossRefGoogle Scholar
  12. 12.
    Catalani C, Findley S, Matos S, Rodriguez R. Community health worker insights on their training and certification. Prog Community Health Partnersh. 2009;3(3):227–35.CrossRefGoogle Scholar
  13. 13.
    Arora S, Kalishman S, Dion D, Som D, Thornton K, Bankhurst A, et al. Partnering urban academic medical centers and rural primary care clinicians to provide complex chronic disease care. Health Aff. 2011;30(6):1176–84.CrossRefGoogle Scholar
  14. 14.
    Colleran K, Harding E, Kipp BJ, Zurawski A, MacMillan B, Jelinkova L, et al. Building capacity to reduce disparities in diabetes: training community health workers using an integrated distance learning model. Diabetes Educ. 2012;38(3):386–96.CrossRefGoogle Scholar
  15. 15.
    Zurawski A, Komaromy M, Ceballos V, McAuley C, Arora S. Project ECHO brings innovation to community health worker training and support. J Health Care Poor Underserved. 2016;27(4A):53–61.CrossRefGoogle Scholar
  16. 16.
    Arora S, Kalishman S, Dion D, Thornton K, Murata G, Fassler C, et al. Knowledge networks for treating complex diseases in remote, rural, and underserved communities. In: McKee A, Eraut M, editors. Learning trajectories, innovation and identity for professional development. Springer: Netherlands; 2011. pp. 47–70.Google Scholar
  17. 17.
    Miller WR, Rollnick S. Motivational interviewing: preparing people to change addictive behavior. New York: Guilford Press; 1991.Google Scholar
  18. 18.
    Komaromy M, Duhigg D, Metcalf A, Carlson C, Kalishman S, Hayes L, et al. Project ECHO (extension for community healthcare outcomes): a new model for educating primary care providers about treatment of substance use disorders. Subst Abuse. 2016;37(1):20–4.CrossRefGoogle Scholar
  19. 19.
    Komaromy M, Bartlett J, Manis K, Arora S. Enhanced primary care treatment of behavioral disorders with ECHO case-based learning. Psychiatr Serv. 2017;38(9):873–5.CrossRefGoogle Scholar
  20. 20.
    Rosenthal EL, Rush CH, Allen CG Understanding the scope and competencies: a contemporary look at the United States community health worker field. Progress report of the community health worker (CHW) core consensus (C3) project. C3 Project. 2016. Accessed 29 Sept 2017.
  21. 21.
    Burke BL, Arkowitz H, Menchola M. The efficacy of motivational interviewing: a meta-analysis of controlled clinical trials. J Consult Clin Psychol. 2003;71(5):843–61.CrossRefGoogle Scholar
  22. 22.
    Earth institute one million community health workers: technical task force report. New York, NY: Colombia University. 2011.
  23. 23.
    Perry H, Zulliger R, Scott K, Javadi D, Gergen J, Shelley K, et al. Case studies of large-scale community health worker programs: Examples from Afghanistan, Bangladesh, Brazil, Ethiopia, Niger, India, Indonesia, Iran, Nepal, Pakistan, Rwanda, Zambia, and Zimbabwe. United States Agency for International Development, Washington, DC (US). 2017. Accessed 17 Oct 2017.
  24. 24.
    State Community Health Worker Models. National Academy for State Health Policy. 2017. Accessed 15 Aug 2017.
  25. 25.
    Jaskiewicz W, Tulenko K. Increasing community health worker productivity and effectiveness: a review of the influence of the work environment. Hum Resour Health. 2012;10(38):1–9.Google Scholar
  26. 26.
    Wennerstrom A, Johnson L, Gibson K, Batta SE, Springgate BF. Community health workers leading the charge on workforce development: lessons from New Orleans. J Community Health. 2014;39:1140–9.CrossRefGoogle Scholar
  27. 27.
    Mazzuoccolo LD, Marciano S, Echeverria CM. Implementación de una modalidad de educación médica a distancia en psoriasis (Implementation of a modality of distance medical education in psoriasis). Medicine. 2016;76(6):359–61.Google Scholar
  28. 28.
    Coates EA, Waisbord S, Awale J, Solomon R, Dey R. Successful polio eradication in Uttar Pradesh, India: the pivotal contribution of the Social Mobilization Network, an NGO/UNICEF collaboration. Global Health. 2013;1(1):68–83.Google Scholar
  29. 29.
    Luby SP, Agboatwalla M, Feikin DR, Painter J, Billhimer W, et al. Effect of handwashing on child health: a randomised controlled trial. Lancet. 2005;366:225–33.CrossRefGoogle Scholar

Copyright information

© Macmillan Publishers Ltd., part of Springer Nature 2017

Authors and Affiliations

  • Miriam Komaromy
    • 1
  • Venice Ceballos
    • 1
  • Andrea Zurawski
    • 1
  • Thomas Bodenheimer
    • 2
    Email author
  • David H. Thom
    • 2
  • Sanjeev Arora
    • 1
  1. 1.ECHO Institute, University of New Mexico Health Sciences CenterAlbuquerqueUSA
  2. 2.Center for Excellence in Primary CareUniversity of CaliforniaSan FranciscoUSA

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