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Career Pathways Part II: Developing Skills, Workforce & Sustainable Salaries

All sectors have different required skill sets. The broad categories are hard and soft skills. In healthcare, the difference between hard and soft skills is distinct. Emphasis has focused on developing (clinical) skills, but the skills (communication, collaboration, compassion, critical thinking, time management, ethical behavior, strong work ethic) are the skills most observable by participants and families. Community Health Workers and Promotores who possess the heart and passion to serve their communities also are a skilled workforce that excels at using “skills” to improve participant outcomes and community-level wellness and transformation. El Sol Neighborhood Educational Center has more than 20 years of experience in developing CHW/promotor (CHW/p) training curricula, including founding and developing El Sol CHWs/Ps Training Center. With module topics that span the Spectrum of Prevention, clinical integration, emotional intelligence, health intervention evaluation and more, we focus on individual, holistic growth for each participant. Our training is evidence-informed and holistic, engaging intellectual, emotional.

“Soft skills enhance communication and strengthen collaboration within and across teams, as well as provide a welcoming, efficient staff for our most important audience, our patients.”

— HealthStream Product Manager, Susan Gurzynski-Wells

CHW’s and promotores co-develop all training materials to ensure relevance and that materials meet different learning styles. And our training programs use the principles and techniques of popular education (also known as empowerment or Freirian education), and involve experienced CHWs who design and conduct our trainings. Our Training Center prepares and supports CHWs to perform the full range of CHW roles, including effective data collection and documentation for integration into electronic health records and more more

Curriculum Development

El Sol has created curriculum for CHWs and promotores for the Latinx, African American, Asian American, and Native American communities. Topics include: Mental Health, Diabetes, Healthy Eating, CHWs/Promotores 101, Popular Education, informal learning, care coordination, conflict resolution, leadership, health data collection, interpretation and monitoring, understanding EHR systems, healthcare systems, accessing health services, and more. In addition, El Sol had created educational materials and resource that are used to educate patients and community. Resources include virtual tool kits, videos, webinars, flip charts, games, “plaza comunitaria”, comics, activity books, and theatrical shows.

El Sol develops and trains each CHW/p to promote health within a target community by assisting individuals to adopt healthy behaviors; to serve as an advocate for the health needs of individuals by assisting community residents in effectively communicating with healthcare providers or social service agencies; and to act as liaisons and advocates while implementing educational or case management that promotes, maintains, and improves individual and overall community health and transforming communities. CHWs/ps who are working in Clinic settings receive additional training to deliver health-related preventive services such as blood pressure, BMI and other screenings.

El Sol’s Basic CHW’s/P’s complete 60 hours of comprehensive training, while clinically-focused Community Health Workers complete 120 hours of comprehensive training. CHWs/ps may also continue to advanced traininges per health, social resource, and professional or personal development topic. See Blog #16 to learn more about El Sol Training Center and curriculum (insert hyperlink here).

Employment Solutions

El Sol provides trusted recruiting and staffing services for CHWs/Ps. Because of our expertise in identifying and training this workforce, organizations may engage El Sol to guide their efforts to hire capable personnel. We provide a range of services: onboarding, contract development, hiring and placement, and payroll services for CHWs and promotores. Contact [name], [title] at [email address] to learn more.

Developing Skills and Investing in CHW/P Pipelines

To continue to build critical workforce and respond to health inequities exacerbated by COVID-19, build this critical workforce and prepare for CalAIM’s pending regulations for managed care plans, 66 colleges and universities across California are investing in CHW Certificates of Achievement. Most of these CHW certificate programs consist of at least 20 mandatory units of education and 15 recommended units. Mandatory educational units often include Contemporary Health Problems, Introduction to Public Health, CHW in Health and Promotion, First Aid, Health Systems and Perspectives, Occupation Work Experience in CHWs, and Elementary Statistics.

And the CHW workforce is increasingly recognized as valuable assets; according to the 2021 Bureau of Labor Statistics Occupational Employment Wages, California-based CHWs/Ps earn an hourly mean wage of $25.93.1 This is higher than most other states, excluding New York.

States with the highest employment level in Community Health Workers:2

State

Employment

Employment per thousand jobs

Hourly mean wage

Annual mean wage

New York

California

Texas

Washington

Ohio

7,750

6,740

4,690

2,860

2,300

0.89

0.41

0.38

0.89

0.44

$ 24.21

$ 25.93

$ 20.34

$ 23.14

$ 19.83

$ 50,350

$ 53,930

$ 42,300

$ 48,130

$ 41,240

From all indicators–community and healthcare systems’ demand, CalAIM opportunities, pandemic response, and the call for improved health equity– community health workers and promotores are a growing employment sector that demands qualified, competent workforce, the infrastructure for appropriate training and onboarding, and mechanisms that support sustainable pay. CHWs/Ps generally have a deep passion for and high dedication to their work and the people they serve. Their “soft skills” combined with intelligence and knowledge resulting from training and education make them an extremely valuable and capable workforce when it comes to improving health outcomes, addressing the Social Determinants of Health, improving quality of care, improving patient interactions, and providing social supports. El Sol’s experience shows that Promotores themselves desire these career pathways as long as they retain the identify and characteristics of what makes them promotores. El Sol is leading a regional Workforce Capacity-Building Collaborative to focus on strategies and policies to grow and sustain the CHW/P workforce.

Next Steps in Financing Sustainable Career Pathways for CHWs/Ps:

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Financial return on investment (ROI)

To continue to build critical workforce and respond to health inequities exacerbated by COVID-19, build this critical workforce and prepare for CalAIM’s pending regulations for managed care plans, 66 colleges and universities across California are investing in CHW Certificates of Achievement. Most of these CHW certificate programs consist of at least 20 mandatory units of education and 15 recommended units. Mandatory educational units often include Contemporary Health Problems, Introduction to Public Health, CHW in Health and Promotion, First Aid, Health Systems and Perspectives, Occupation Work Experience in CHWs, and Elementary Statistics.

The program saved an estimated $2 million in health care costs in one year across 448 patients, suggesting close to a 4:1 ROI.3

According to a report by the Center for Health Care Strategies, CHW/Ps have not typically been part of the health care payment system. The health care financing system primarily focuses on reimbursing licensed providers who deliver clinical services to patients. CHW/Ps’ unlicensed status, along with their “soft skills”, do not easily fit into this funding framework. Currently, there is a modicum of Medicaid funding options for CHW/Ps: 4

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Medicaid Managed Care

 The Centers for Medicare & Medicaid Services’ (CMS) Medicaid managed care regulations authorize the use of CHW/Ps for services covered by managed care plans (MCPs), such as health education, navigation, and care coordination.

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Medicaid State Plan Amendments (SPA)

 Some SPAs expand the authority for CHW/Ps to provide services, and several are particularly relevant to CHW/Ps’ efforts in California, including:

 Health Homes – California’s health home SPA supports care coordination for Medicaid beneficiaries with complex health needs and includes an option to include CHW/Ps as part of the health home care team. 

Preventive Services

Targeted Case Management (TCM) – The Alameda County Health Services Agency, a local governmental agency, contracts with a community clinic to provide its TCM services through a Transitions Clinic Network program that employs CHW/Ps.

 Whole Person Care (WPC) pilots are funded through the state’s 1115 demonstration waiver and a majority of participating agencies and organizations are supporting CHW/P efforts

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Grant Funding

Grants account for a substantial portion of financing for CHW/P programs. These can be critical short-term mechanisms. However, it is also by nature fleeting and not considered a “sustainable” source of revenue.

Conclusion

CHWs/Ps, health care systems, managed care plans, and government must continue to work together to create sustainable funding to integrate the vital “soft skills” of CHWs/Ps. ROI’s and community need suggest that this added value is well-worth the investment of time and effort. Contact Alex Fajardo, Executive Director at alexfajardo@elsolnec.org  to learn more about policy work to sustain the CHW workforce and to get involved with the El Sol Workforce Capacity-Building Collaborative, funded by the California Healthcare Foundation.

[1]https://www.bls.gov/Oes/current/oes211094.htm
[2] https://www.bls.gov/Oes/current/oes211094.htm#(1)
[3] https://www.chcs.org/media/CHCS-CHCF-CHWP-Brief_010920_FINAL.pdf

[4]https://www.chcs.org/media/CHCS-CHCF-CHWP-Brief_010920_FINAL.pdf

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