Employer Resources

Please visit our calendar to add events and our job board to post CHW positions. 

Employer Resource Center 

Our Employer Resource Center provides easy access to evidence-based practices for designing and implementing Community Health Worker programs. We are an online and onsite resource for accountable care organizations (ACOs), hospitals, community health centers and other social service providers considering or currently implementing a CHW program. We also convene CHW employers for peer-to-peer learning and exchange.  

MACHW also offers onsite consultation and training. We are proud to announce we now offer a 20-hour training for new hires. The training will ready CHWs to understand and work within ACOs and systems of care. The training will also provide tools for communicating effectively with their care teams and with patients with complex chronic conditions. This training is the product of a partnership between MACHW, the Justice Resource Institute (JRI), and the Center for Primary Care at Harvard Medical School. 

To hire MACHW for technical assistance or training needs, contact Lissette Blondet at [email protected]. 

Why CHWs? 

CHWs bring many strengths to their work, such as developing trusting relationships with patients, particularly for underserved, minority populations facing cultural and linguistic barriers to care; improving health outcomes, especially among those with chronic illnesses; and reducing healthcare costs by decreasing emergency department visits and hospitalizations. 

Source: https://www.commonwealthfund.org/publications/2015/dec/focus-integrating-community-health-workers-care-teams & https://pubmed.ncbi.nlm.nih.gov/24309397/  

Critical Success Factors 

Leadership must ensure that existing staff and providers know that hiring a CHW could lead to a significant cultural shift within the organization. A CHW may alter how the organization operates internally and meets the needs of its clients and patients, so it is recommended to have sustained and frequent communication regarding how best to incorporate input from the new CHW(s). 

1. A powerful CHW champion. 

   A CHW champion is essential to the success of the CHW model. The champion ensures that the administration and clinical team members understand and support the model.

2. Organizational commitment to the CHW program. 

   The hospital may want to make changes to procedures to accommodate CHWs by implementing a detailed job description, division of labor, recruitment criteria and process, and tracking and evaluation of CHW contributions.

3. Train clinical teams on the CHW model. 

   To implement a successful CHW) model, clinical teams should receive training on the program’s mission and vision, CHW roles, and shared supervision. Staff training is also recommended to improve integration and eliminate the tension between CHWs and other team members. CHWs can provide valuable information about patients’ backgrounds, constraints, and preferences to help the team better understand each patient.

4. Employ a CHW supervisor/administrator as an intermediary.

   Employing a CHW supervisor/administrator can strengthen communication, provide more focused supervision, allow for program development, convey the value of CHWs’ work, and illustrate career advancement opportunities.

5. Highlight improved outcomes and lower costs.

   Providing evidence of the benefits of CHWs to staff is critical for obtaining organizational, administrative, and team-wide support.  

Source: Minnesota Community Health Worker Toolkit & https://pubmed.ncbi.nlm.nih.gov/24309397/  

Lessons Learned 

1. Co-locate Community Health Workers in patient centered medical home practices. 

   Co-locating CHWs in the PCMH practices reduces staff turnover, integrates CHWs into existing communication structures, and encourages patients to use self-management support services (SMS).

2. A significant portion of CHWs’ time should be invested in community-based activities.  

   Maintaining trust is essential to address health determinants at all ecological model levels. CHWs in the PCMH model can connect communities to health institutions. Community outreach is a critical part of being a CHW, and the amount of time spent in the field should support their work within the healthcare setting.

3. Ensure clinical staff clearly understands CHWs’ roles and strengths on the team. 

   Defined roles for CHWs improve their ability to contribute to team-based care, reduce confusion, and ultimately provide better patient care.

4. Ensure CHWs receive extensive, competency-based training from established capacity development programs. 

   While some difficulties can be overcome with ongoing mentorship and support of PCMH clinical staff, the program benefits when CHWs receive 80-hour capacity-building training and are provided the support to become certified. 

5. Improve the Efficient Referral System (ERS).  

   To avoid overlooking patients needing the most help, medical institutions should consider referring patients with poorly controlled diseases to CHWs through a process separate from ERS.

6. Train CHWs to enter data in Electronic Medical Records (EMRs): 

   Limited EMR access can improve communication and efficiency, and documentation tools can focus on personalized support. Having access to EMRs allows Community Health Workers to collect data on medication use, disease self-monitoring, and physical activity levels. 

7. Develop a simple tool to lend structure to CHW–patient encounters. 

   A brief guide for Community Health Workers should cover social assets, barriers, support needs, medication use, dietary and physical activity patterns, self-monitoring and goal setting, and education topics. The guide should be simple enough to allow flexibility in addressing individual patient needs. 

8. Prepare CHWs to address comorbid mental health conditions in a culturally appropriate fashion.  

   To address mental health conditions in a culturally appropriate manner, support CHWs through training, mentorship, and communication. CHWs can also help shape programs to adapt to patient preferences, such as providing group medical appointments or community-based learning for populations that prefer community-oriented information. 

These takeaways are adapted from Integrating CHWs into a PCMH to Support Disease Self-Management Among Vietnamese Americans: Lessons Learned. 

Hiring 

Successful Community Health Worker programs require careful planning for the hiring, supervising, and training of CHWs, their supervisors, and the clinical team. Programs that underestimate the importance of these factors may require mid-course corrections or risk failure. Employers can save time and resources by customizing HR processes for CHWs. 

A CHW’s background and personality traits should weigh more heavily in the hiring decision than their level of education. General consensus within the field is that the skills and traits which make CHWs successful are inherent or gained through work and life experience. The technical skills and specific health knowledge needed for a CHW position can be learned through sufficient on-the-job training. Employers should hire CHWs with positive communication skills, adaptability, reliability, strength, and both passion for and sensitivity to community issues. 

The process of hiring CHWs should be structured to be equitable and ensure the program employer is upfront with the CHW about the expectations of the position. Interviews should cover logistical questions, community experience, passion for the job, comfort with the position requirements, and overall work experience. 

Key skills and traits required for CHWs can be found in the Minnesota Community Health Worker Toolkit. 

Sources: Community Health Worker Integration into a Healthcare Team:  A Bronx Tale 

Job Descriptions 

A well-developed job description helps define the parameters of the role for the Community Health Worker, their supervisor, and all the health care professionals who refer to and collaborate with the CHW.  When shared with the team, a well-developed job description can serve as a guidepost for how to maximize the benefit of the CHW in the workplace.    

The CHW Core Competencies provides a framework for understanding the broad scope of activities that CHWs carry out day to day in many different settings. The ten core competencies establish a scope of practice. While not all CHWs will practice all competencies, they may take on any combination of these roles depending on the needs of their community. 

CHW job descriptions are diverse and dependent on organizational needs. The Minnesota Community Health Worker Toolkit identifies critical considerations for developing a job description, including: 

• Primary duties (e.g., home visiting, patient education) 
• Personal skills (e.g., empathy, ability to establish trusting relationships, interest in helping the community) 
• Prior health and other related work experience (including knowledge of community) 
• Language requirements (e.g., both oral and written, English, other languages) 
• Physical requirements (e.g., transporting education materials, walking and stair-climbing to visit patient homes) 
• Special skills (e.g., computer skills, EHR experience, phone calling skills, driver’s license) 

Salary 

MACHW navigates for an average minimum hourly wage of $27 – 35/hour for CHWs, based on experience. This recommendation is based on a 2020 report by the Center for Social Policy: MACHW Salary Recommendations Updated 7.15.2020 (2) 

Here is the full report: Full Salary Study by UMASS 

New Hire Training 

Initial CHW Training 

Most newly hired CHWs will bring relevant work experience, personal lived experience, and some formal or on-the-job training. Due to significant barriers to entry, many CHWs have gaps in formal education and training. Employers will find investing in upfront and ongoing training of CHWs is productive and cost-effective. 

CHW training should: 

• Introduce CHWs to their roles, goals, and parameters of their work, 
• Provide foundational knowledge and skills in working with complex and chronic conditions, 
• Prepare CHWs to integrate into their clinical teams, and 
• Introduce CHWs to critical administrative and documentation systems. 

Core Competency Training 

Massachusetts is a national leader in defining Community Health Worker Core Competencies and in providing a pathway for CHW Certification.  CHW Core Competencies are considered foundational skills for all Community Health Workers, regardless of role, and certification is NOT required for employment.  

While some new employees may have attended a formal CHW Core Competency Training Program, many will not have had this opportunity prior to employment. CHW Core Competency Trainings are offered regionally across Massachusetts. Employers typically pay for CHWs to attend this fundamental skill-building training within their first year of employment. Information on CHW Core Competency Trainings across Massachusetts and information on CHW Certification can be found here. 

Additional Training Components 

• Human Resources Orientation to CHW Hiring: HR Depts are unaccustomed to asking people about their life experience and are trained to avoid such questions.  Successful CHW hiring requires nuanced tailoring of traditional HR processes. CHW Human Resources Orientation to CHW hiring can be arranged through the CHW Employer Resource Center by contacting Lissette at [email protected]. 
• CHW Supervisor Initial Training: CHW Supervisor Training can be arranged through the Regional CHW Training Centers.  
• Team Initial Training: CHW Employer Resource Center can provide orientation and training on best practices for integrating Community Health Workers to maximizing program value and impact. 
• Ongoing Professional Development: MACHW hosts professional development workshops which may offer continuing education credits. Please visit our events page to see upcoming opportunities.  
• On-The-Job Training: A regular, consistent schedule of on-the-job training is essential to a fledgling CHW program.  As a workforce that is not required to receive professional training prior to employment, CHWs require a unique level of training and investment.  Planning the time and resources for regular staff development is critically important to the success of this workforce.  Employers can take advantage of training resources through a network of CHW Training Centers across MA. Topics for ongoing training might include: 

• Motivational interviewing 
• Health-specific interventions and protocols ·       
• Complex chronic conditions 
• Behavioral health with an emphasis on trauma 
• Substance abuse 
• Domestic violence 
• Goal setting 
• Social determinants of health 
• Cultural mediation 
• Working with primary care teams 
• CPR 
• Safety and Self-Care 

Determining Workload 

A time or task-based analysis can assist employers in determining position workloads and evaluating staffing needs. General practice is also illustrative in determining CHW workload. Some key considerations for workload include: 

• Complexity of patient health issues and social needs; 
• Number of tasks/focus areas in the program; 
• Organization and tools to assist CHW in workload; 
• Documentation requirements; and, 
• Distance traveled or time needed to travel between clients (especially for home visiting programs) 

In their successful integration of Community Health Workers into a Patient-Centered Medical Home, the Bronx-Lebanon Hospital PCMH conducted a CHW time study to in part to educate the Care Team about the time CHW spent working in the community. “Almost half of CHW work is devoted to home visits (25%) and outreach and follow-up (16%), with direct interactions with patients… These interactions allow CHWs to build a trusting relationship and teach self-care and disease management methods. These interactions aim to support the patient’s progression toward achieving their disease management goals as established in their original visit with the CHW. All CHWs are expected to make 2 home visits per day and 3 joint clinic/hospital visits per day. The balance of time is split among additional activities, including writing up case narratives.”  

Source: https://pubmed.ncbi.nlm.nih.gov/24309397/ 

Supervision 

CHWs require skilled, supportive, and attuned supervisors to guide the appropriate and strategic use of CHW skills. These supervisors provide regular coaching and guidance on CHW practice, develop and implement CHW protocols, and advocate for the full integration of CHWs within the larger clinical team. The supervisor role includes:  

• Establish Work Structure and Assist CHWs in Setting Professional Boundaries 
• Mentor CHWs 
• Monitor CHWs and Manage Performance 
• Ensure CHW Adaptation of Work Culture 
• Find the Right Balance Regarding CHW Autonomy 
• Foster CHW Professional Growth and Recognize CHW Work 

Best Practices 

• CHW supervisors themselves must be provided with adequate support by management. Supervisors should have workloads that allow time to provide regular supervision to CHWs and to address concerns of the CHW as they arise.  Training on the CHW model, duties and roles, in addition to CHW supervision may be beneficial to those supervisors new to the role. 
• Supervisors should mentor and be available to support CHWs. CHWs should provide appropriate mentoring to CHWs to help them overcome challenges, manage their workload, and deal with complex patient cases.  These actions can help prevent low morale and protect against CHW burnout.  Supervisors should understand both the CHW’s personal as well as professional demands, demonstrate appropriate flexibility and if needed, help CHWs adapt to work culture. 
• Supervisors should monitor CHW performance and set reasonable expectations. Supervisors should help CHWs understand the level of demand and commitment required for the job, provide a reasonable workload, help CHWs develop professional boundaries and hold workers accountable.  CHWs should be periodically evaluated and provided with constructive feedback on any additional training needs or areas for improvement.  Finally, it is recommended that supervisors shadow CHWs in their work both a) to gain a deeper understanding of the CHW’s day-to-day work and b) to evaluate CHW performance. 
• Supervisors should provide CHWs with adequate autonomy, recognize their contribution and foster CHW professional development. CHWs play an important role in the intervention and should be treated as full members of the healthcare delivery team.  Treating CHWs as such will not only facilitate the recognition of their contribution but will also communicate the value of their position to other staff and community partners. 

Source: CHW Supervision, Sinai Urban Health Institute Best Practice Guidelines for Implementing CHW Programs in Health Care Settings, 2014 

Structures 

Supervisors will find it most effective to use multiple formats, including individual supervision, group supervision, and case review/conference style supervision as described in the MA Department of Mental Health’s Supervision Manual. The Massachusetts Department of Public Health recommends that a full-time CHW supervisor should have no more than 7-8 supervisees if she/he is also expected to manage administrative, clinical or fiscal responsibilities. Three different supervision structures are described below. 

• Individual Supervision. One-on-one supervision is essential for all staff to discuss performance, challenges, successes, and to provide support for CHWs who are working with diverse clients with varied and profound health and social barriers. CHWs should meet individually 1-2 times a month with their supervisor. Cases need to be reviewed in both individual and group supervision. 
• Group Supervision. Group supervision is not an alternative to individual supervision but recommended as a supplement. Groups can be used to inform and coach on programmatic, administrative, and clinical issues.  When working through specific cases and scenarios, there is a significant benefit to having peers in the room together for team building and mentorship of less experienced CHWs. Some programs use group supervision as a way to increase supportive supervision. For example, a mental health clinician can lead a group supervision session to offer behavioral health specific support. This role would be an additional supervisor position if the CHW supervisor does not have a background in behavioral health. 
• Case Reviews/Conferences. These meetings take place with other members of the care team, including medical and behavioral health clinicians. The case review model gives CHWs a chance to add to the knowledge and observations about a patient and to articulate their expertise and unique perspective. 

Performance Evaluation 

In one study, six factors were identified for influencing CHW motivation and performance: 

Although this research is primarily drawn from CHW program experience overseas and the description reflects international contexts, the six factors are relevant to CHW performance in the US.  

At Bronx-Lebanon Hospital, they developed a set of performance evaluation tools to support routine interactive supervision which includes: 

• Weekly time assessment by specific task; 
• Bimonthly performance enhancement reporting, allowing the CHW [supervisor] to compare weekly CHW time spent per activity, relative to the CHW group average; and 

• Quarterly home visit performance evaluation, with the home visit observed by the CHW Administrator or her senior designate. 

The home visit evaluation covers the CHW opener or explanation of visit purpose, efforts to build a trusting relationship, and teaching skills. Depending on the specific activity, the CHW Administrator uses the observations to give encouragement and praise where the visit activity was well done and to discuss steps to improve the visit where the activities were less effective. The supportive nature of this performance evaluation has made it well-received, which in turn generally has led to performance improvement. The 3-month evaluation is particularly critical as this is the end of the probation period.  

Source:   https://pubmed.ncbi.nlm.nih.gov/24309397/ & Minnesota Department of Public Health CHW Toolkit: A Guide for Employers