January 2010

Grant Results

SUMMARY

From 2006 to 2009, staff members at the Georgetown University Law Center, Washington, worked to raise the profile and influence of community health workers in the health care system and among policy-makers.

Community health workers, who work either in a paid or volunteer capacity, help members of their communities navigate the health care system. They typically focus on underserved populations, such as low-income children and adults, and people of color. They have not had much power or influence in the health care system, and remain its least trained and most poorly paid workers, according to Robert Stumberg, J.D., at Georgetown University Law Center.

Key Results
During this grant, project staff:

  • Created much of the infrastructure for a new, national organization designed to represent community health workers. Staff members and community health workers put together key building blocks for the newly established American Association of Community Health Workers, including the documents necessary to gain nonprofit status. As of October 2009, the organization had not been incorporated.
  • Provided technical assistance to state community health worker associations. Staff provided assistance to community health worker associations in Maryland, Massachusetts, Minnesota, New Jersey, New York and Ohio, as well as in Washington, D.C.

Funding
The Robert Wood Johnson Foundation (RWJF) funded this project with a grant of $240,000 between August 2006 and January 2009.

 See Grant Detail & Contact Information
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The Problem

Community health workers, who work either in a paid or volunteer capacity in the local health care system, typically share the ethnicity, language, socioeconomic status and life experiences of the community members they serve. Usual responsibilities might include:

  • Interpretation and translation services.
  • Providing culturally appropriate health education and information.
  • Helping people receive the care they need.
  • Providing informal counseling and guidance on health behaviors.
  • Advocating for individual and community health needs.
  • Providing direct services, such as first aid and blood pressure screening.

Community health workers generally focus on underserved populations, such as low-income children and adults, and people of color, and are sometimes called community health advisers, lay health advocates, promotoras, outreach educators, community health representatives, peer health promoters or peer health educators.

Despite their importance, community health workers have not had much power or influence in the health care system or among policy-makers. They remain the least trained and most poorly compensated workers in the health care workforce, according to Robert Stumberg, J.D., at Georgetown University Law Center.

When this project was launched, there were 18 statewide community health associations, but no national association representing community health workers.

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RWJF Strategy

RWJF has occasionally supported the field of community health workers. For example:

  • A 1998 project with Freedom From Hunger trained lay health workers. See Grant Results.
  • African-American hair stylists in eight Michigan cities were trained to provide health information to their clientele. See Grant Results.
  • From 1995 to 1998, Community Health Care in Bridgeton, N.J., developed a program to train farmworkers in Cumberland County to become lay health promoters. See Grant Results.
  • Also see this section of a Grant Results Topic Summary on immigrants, "Community-Based Health Outreach."
  • In addition, RWJF has supported community health workers to help people manage their diabetes and asthma and in other ways. See these search results.
  • RWJF has also supported the SkillWorks Community Health Worker Project in Boston (ID# 052739), which seeks advancing the low-wage of the community health workforce.

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The Project

From 2006 to 2009, staff members at the Georgetown University Law Center, Washington, worked to raise the profile and influence of community health workers in the health care system and among policy-makers.

Activities

During the grant, project staff organized and supported four committees that helped to frame and approve the documents necessary to create an American Association of Community Health Workers:

  • Steering committee
  • Policy committee
  • Vision and bylaws committee
  • Membership and outreach committee

The 15-member steering committee reflected the racial, cultural and geographical diversity of community health workers. All of the committees worked via monthly conference calls and at meetings scheduled to coincide with other national conferences, including the American Public Health Association annual meeting.

Project staff also provided technical assistance to state community health worker associations and one-on-one support to develop leadership skills among community health workers.

Challenges

Project staff reported these key challenges:

  • At the start of the project, there was little consensus about the need for community health workers to work together, as well as the policies, plans and leadership necessary to make collaboration happen. It took some time for participants to recognize that it was in the best interests of the profession to find common ground. Project staff dedicated significant staff time to facilitating and encouraging conversations among groups of community health workers to foster collaboration.
  • There were significant divisions among community health worker leaders tied to race, culture, paid or volunteer status, geography and experience. In addition, those with prior leadership experience wanted to maintain their independence while those new to the profession were trying to find their place and make their mark. Technical assistance from project staff helped to overcome some of the resulting communication barriers.
  • Community health worker leadership had to make trade-offs between their time commitments to state and national efforts. During the grant, more state-based community health worker associations emerged, which placed more demands on leaders in those states. At times, their efforts to build a national association took a back burner to their commitment to build and sustain state organizations.
  • High turnover among community health worker leadership left a gap in the skills and experience needed to build a national organization. While it is very important that community health workers have opportunities to be promoted, their departure sometimes dealt a blow to efforts to build a national association. Some leaders also lost their jobs due to budget cuts or because a grant came to an end.

Other Funding

The project also received funding from the Morehouse School of Medicine, Office of Community Health and Georgetown University Law Center.

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Results

In a report to RWJF and an interview, project staff indicated that they had:

  • Created much of the infrastructure for a new, national organization that represents community health workers. Staff members and community health workers put together the building blocks of a proposed national association, the American Association of Community Health Workers, including drafting the key documents necessary to gain nonprofit status.

    As of October 2009, the organization had not been incorporated.
  • Provided support to community health worker associations in six states—Maryland, Massachusetts, Minnesota, New Jersey, New York and Ohio—and in Washington, D.C. For example, project staff provided technical assistance to help the Maryland association to reorganize and the New York association to develop proposals for funding community health worker services.
  • Took steps to strengthen the professional visibility of, and appreciation for, community health workers within the health care system. For example, project staff:
    • Assisted an American Public Health Association group to define the community health workforce and to guide the U.S. Department of Labor in developing a standard occupational code for these workers.
    • Developed a model code of ethics for community health workers.
    • Facilitated linkages among state organizations, employers and other stakeholders to exchange best practices for training.
    • Examined opportunities to use community health workers in ways that will save the system money—for example, by guiding health consumers towards community clinics instead of emergency rooms.
  • Developed leadership capacity. Staff provided one-on-one training to community health workers to help them develop the speaking, writing and negotiating skills necessary to become effective advocates, work collaboratively and represent the interests of members of their field to public officials.

Communications

Project staff wrote several policy briefs, including one focused on integrating community health workers into state Medicaid programs. They also produced a "code of ethics" toolkit for community health workers. See the Bibliography for details.

Staff also presented at several national, state and local conferences, including the American Public Health Association annual meeting, the Massachusetts Association of Community Health Workers meeting and the Community Health Worker Network of New York City.

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Lessons Learned

  1. Take the time to mediate differences so that stakeholders can work together on larger goals. Project staff had not anticipated the level of distrust and animosity among community health worker leaders who represented different regions and ethnic groups and came from varying professional backgrounds. "Often in communities you're effective if you are a squeaky wheel. People had sharpened their conflict skills but not their collaboration skills," said Project Director Robert Stumberg, J.D.
  2. Decide where the most impact can be made and focus energies there. Project staff divided their time between working to establish a national association of community health workers and providing technical assistance to state associations. Both areas were valuable but it might be better to focus on one area at a time when seeking to build a field. (Project Director)

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After the Grant

Leaders within the community health worker movement continue to meet but as of October 2009, the national nonprofit association had not been incorporated. The grantee organization has offered to complete the necessary legal tasks on a pro bono basis.

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GRANT DETAILS & CONTACT INFORMATION

Project

Integrating community health workers into the health care system by creating a national network to strengthen and sustain their workforce

Grantee

Georgetown University Law Center (Washington,  DC)

  • Amount: $ 231,357
    Dates: August 2006 to June 2009
    ID#:  055510

Contact

Robert Stumberg, J.D., LL.M.
(202) 662-9603
stumberg@law.georgetown.edu

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BIBLIOGRAPHY

(Current as of date of this report; as provided by grantee organization; not verified by RWJF; items not available from RWJF.)

Reports

Community Health Worker Code of Ethics Toolkit. Washington: Harrison Institute for Public Law, 2008.

Could a Dental Hygienist Work in a Pediatric Practice? Washington: Harrison Institute for Public Law, 2008.

Massachusetts Association of Community Health Workers Bylaws. Washington: Harrison Institute for Public Law, 2007.

Strategies for Integrating Community Health Workers into State Medicaid Programs. Washington: Harrison Institute for Public Law, 2007.

Toolkit for Corporate Organization: The American Association of Community Health Workers. Washington: Harrison Institute for Public Law, 2008. Toolkit includes:

  • AACHW Vision Statement
  • AACHW Mission Statement
  • AACHW Goal Statement
  • AACHW Code of Ethics
  • AACHW Membership Brochure
  • AACHW Draft Bylaws
  • AACHW Draft Articles of Incorporation
  • AACHW Survey

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Report prepared by: Susan G. Parker
Reviewed by: Karyn Feiden
Reviewed by: Molly McKaughan
Program Officer: Sallie Anne George

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