By: CHW Central
Each of the APHA CHW Section sessions that I attended today was well-attended and full of active participation. Most presenters started by saying how inspired they felt to be presenting at the conference and to an audience of their peers. Throughout the day we heard of successes, challenges, integration and training. There were several topics that really seemed to capture the attention of presenters and the audience alike. They were:
Remuneration and experience:
Unsurprisingly in the first session “integrating CHWs into systems of care: bridging the community and clinic” the subject of payment came up. “What do you pay your CHWs and what is the level of education that you look for?” an audience member asked the panel. Their answers were all over the map, from $15.00 per hour at one program to $21.50 per hour at another. For experience, some programs seek candidates with only a high school diploma while others said that they had candidates with masters degrees who applied. While there was no consensus on the subject of remuneration, there was consensus that level of education was not nearly as important as relationship experience. CHWs need to be able to gain the trust of their clients through discussions, visits, and follow-up. It was even noted that in some cases candidates with clinical experience were not as effective as those without, perhaps because of their willingness to diagnose rather than just listen.
Challenges of integration:
In each session there were comments that addressed the challenges of integrating CHW programs into existing health systems. For one program, the issues ranged from billing (figuring out how to code and bill CHW time) to immigration (with government funds meant strict rules that only US citizens could be hired as CHWs). For other programs, the issues lay in building the confidence of their CHWs to make sure that they were invited to clinic/health center meetings and part of discussions. Others still have to deal with nurses, social workers, and even physicians viewing the CHWs as possible threats to their positions. However, in this last case the organization said they work to make it abundantly clear that CHWs are not “physician extenders” or “task-shifters”; they are members of the community that provide services that can’t be done by others in the health care system. They serve a unique purpose which means they work alongside other members of the health care system and not in competition with them.
Training and Certification:
Throughout the day I heard arguments both for and against a standardized certification program for CHWs. Of the most compelling arguments against was a program manager saying “you can’t train someone to love and to want their community to be healthy,” but even she said she understood that with funding came some kind of necessary credentialing. There was also a CHR (Community Health Representative) from the Navajo Nation who explained that for them it was important to translate the idea of “wellness” into Navajo in order to meet the needs of their people. How would that work in a standardized certification process?
But on the flip side there are some organizations that have made great strides in certification. They have offered free, online courses and trainings that are in most cases exactly what someone who is thinking of starting a CHW program can use. You can find some of those here.
In the end I think the strongest point that was made was that CHWs make a profound difference in the lives of the people that they serve. They are meant to be rooted in the community but at the same time they have to be integrated into the larger health care system in some way.
-CHW Central
Leave a Reply