![]() Approximately 20 states have developed certification standards these are intended to enhance the credibility of qualifying professionals, increase service quality, and assure those served of CHW competency. However, there are nationally recognized CHW skills and competencies. Nationally, there are no unified training standards for CHWs. In most states, CHWs and promotores de salud work outside of any system of formal certification. CHWs may be employed by a clinic, hospital, health department, or community-based organization, or as volunteers. CHWs build individual and community capacity by increasing health knowledge and self-sufficiency through conducting outreach, providing education, connecting communities to social support services, and advocacy. Their community membership, language, and cultural relationships allow CHWs and promotores de salud to bridge health care and social services divides within the current population health service system, facilitating the delivery of health promotion and culturally informed interventions. Promotores de salud are a subset of CHWs who primarily serve Latinx communities and are grounded in a social, rather than a clinical model of care. Positioning CHWs as decision makers will be critical when designing state certification processes.Ĭommunity health workers (CHWs), including promotores de salud, are trusted members of the community who have an intimate understanding of the population they serve. ![]() To address participant concerns, our findings recommend California stakeholders build a voluntary certification process structured with multiple pathways to overcome entry barriers of traditional certification processes, maintain CHW identity, and protect diversity within the workforce. CHWs, program managers, and system-level participants agreed that CHWs should be involved in certification discussions and decision making. Program managers and system-level participants also highlighted that certification may not address all challenges related to integrating CHWs into health care systems. Some program managers and system-level participants acknowledged the opportunities of certification but also expressed concerns that certification may distance CHWs from their communities. Some CHW participants supported inclusive certification training opportunities while others feared that certification might erode their identity and undermine their work in communities. We used a thematic analysis approach to identify, analyze, and report themes. We conducted focus groups with CHWs, interviews with program managers and system-level participants, and observations of public forums that discussed CHW workforce issues. ![]() We employed purposive sampling to interview 108 stakeholders (i.e., 66 CHWs, 11 program managers, and 31 system-level participants) to understand their perspectives on the opportunities and risks that certification may raise for CHWs and the communities they serve. California’s CHW workforce represents distinct ideologies of care (e.g., clinical CHWs, community-based CHWs, and promotores de salud) and California stakeholders have debated certification for nearly twenty years but have not implemented such processes. ![]() California serves as an ideal case study to examine how these two paths can coexist. For community health workers (CHWs) and promotores de salud (CHWs who primarily serve Latinx communities and are grounded in a social, rather than a clinical model of care), the process of certification highlights the tension between developing a certified workforce with formal requirements (i.e., certified CHWs) and valuing CHWs, without formal requirements, based on their roles, knowledge, and being part of the communities where they live and work (i.e., non-certified CHWs).
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