Don't change who we are but give us a chance: confronting the potential of community health worker certification for workforce recognition and exclusion

Ashley Kissinger; Shakira Cordova; Ann Keller; Jane Mauldon; Lori Copan; Claire Snell Rood

doi:10.1186/s13690-022-00815-4

Don't change who we are but give us a chance: confronting the potential of community health worker certification for workforce recognition and exclusion

Arch Public Health. 2022 Feb 21;80(1):61. doi: 10.1186/s13690-022-00815-4.

Authors

Ashley Kissinger¹, Shakira Cordova², Ann Keller², Jane Mauldon³, Lori Copan⁴, Claire Snell Rood²

Affiliations

¹ Center for Healthy Communities, Environmental Health Investigations Branch, California Department of Public Health, 850 Marina Bay Parkway, Building P-3, CA, 94804, Richmond, USA. Ashley.kissinger@cdph.ca.gov.
² School of Public Health, University of California, Berkeley, CA, USA.
³ Goldman School of Public Policy, University of California, Berkeley, CA, USA.
⁴ Center for Healthy Communities, Environmental Health Investigations Branch, California Department of Public Health, 850 Marina Bay Parkway, Building P-3, CA, 94804, Richmond, USA.

Abstract

Background: 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). California serves as an ideal case study to examine how these two paths can coexist. 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.

Methods: 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. 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 used a thematic analysis approach to identify, analyze, and report themes.

Results: Some CHW participants supported inclusive certification training opportunities while others feared that certification might erode their identity and undermine their work in communities. Some program managers and system-level participants acknowledged the opportunities of certification but also expressed concerns that certification may distance CHWs from their communities. Program managers and system-level participants also highlighted that certification may not address all challenges related to integrating CHWs into health care systems. CHWs, program managers, and system-level participants agreed that CHWs should be involved in certification discussions and decision making.

Conclusions: 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. Positioning CHWs as decision makers will be critical when designing state certification processes.

Keywords: Certification; Community health; Community health workers; Promotores de salud; Qualitative methods; Workforce development.