This post highlights how the Community Health Worker Toolkit: Capacity Building in Local Health Departments may be used to support local health departments in recruiting and retaining community health workers. 

Timely Funding

In mid-2021, the Centers for Disease Control and Prevention (CDC) awarded approximately $2.25 billion to 108 recipients as part of its National Initiative to Address COVID-19 Health Disparities Among Populations at High-Risk and Underserved, Including Racial and Ethnic Minority Populations and Rural Communities (OT21-2103) grant. Under this initiative, local health departments (LHDs) received funding to enhance their capacity and capability to address health disparities related to COVID-19. In 2023, the National Association of County and City Health Officials (NACCHO) funded the Center for Public Health Systems (CPHS) at the University of Minnesota School of Public Health to assist LHDs with hiring and retaining community health workers (CHWs) through the creation of a toolkit. 

CHWs are increasingly integral to LHDs’ ability to collaborate and communicate with the communities that they serve on pressing health-related issues. As well-trusted community members who have an in-depth understanding of local populations, CHWs are also skilled at serving as a connection between health/social services and community members, facilitating access to services. The NACCHO 2022 National Profile of LHDs estimates that there are 5,900 CHWs working in LHDs and that CHWs are a growing part of the LHD workforce, yet turnover remains high. In particular, research has shown that when CHWs are dissatisfied with organizational support, pay, or job security, they have a probability upwards of 50% of reporting an intent to leave their position. CHW turnover has critical implications for LHDs. This toolkit aims to provide LHDs with information and tools on best practices in recruiting and retaining CHWs.

Shaping the Toolkit

To create the Community Health Worker Toolkit: Capacity Building in Local Health Departments, CPHS, with support from NACCHO, first conducted an environmental scan of available literature on effective hiring and retention strategies for CHWs. CPHS also consulted with subject matter experts, including CHWs and leaders of CHW organizations. Once the toolkit began to take shape, CPHS gathered feedback by hosting a listening session and conducting a feedback survey with LHDs across the U.S. to ensure that the toolkit included relevant information and meaningful guidance. Additionally, CPHS consulted with field experts to create tools and provide examples of CHWs in LHDs. Contributors to the toolkit included Umemba Health, LCC; Nicollet County Health and Human Services (Minnesota); Dakota County Public Health (Minnesota), and the Center for Community Health Alignment (South Carolina). The environmental scan report and CHW Toolkit can be found on the NACCHO website and the CPHS website.

Community Health Worker (CHW) Toolkit

The resulting toolkit provides comprehensive guidance on the following:

• The Importance and Role of CHWs in LHDs
• Integration of CHWs and Effective Outcomes of CHWs
• CHW Expertise
• Strategies for Reviewing CHW Candidates
• Diversity Among CHWs
• CHW Recruitment Strategies
• CHW Salary and Funding
• Improving the CHW Hiring Process
• CHW Retention Strategies
• Recognition and Signs of Work Burnout
• Leadership and Support
• How CHW Associations Can Support CHWs

The toolkit includes eight tools and assessments developed by Umemba Health, LCC to assist LHD leadership with recruiting and retaining quality CHWs:

1. Behavior-Based Interview Questions for CHWs
2. CHW Person-Based Recruiting
3. CHW Skill-Based Assessment Template
4. CHW Inclusive Job Description Assessment
5. Ten Ways to Expand Your CHW Recruiting Efforts
6. Organization Hiring Assessment
7. CHW Training Tip Sheet
8. CHW Career Ladder

CHW Integration within LHDs

The toolkit discusses the importance, role, and integration of CHWs into LHDs and also provides current examples regarding how CHWs are integrated within LHDs. For example, Amalia Roberts from Dakota County, Minnesota, shared:

Similarly, Breanna Allan from Nicollet County, Minnesota, shared how CHWs are integrated in their LHD:

These examples provide LHDs with ideas on how they could integrate CHWs into their departments.

Another challenge LHDs often face when adding and hiring for open CHW positions is deciding which qualifications applicants should have to be eligible for hiring. CHW certification and degree requirements, which can be beneficial for standardization and regulation, also raise concerns around equity vis-a-vis career path accessibility, especially to underserved communities. When deciding whether to require CHW certification, consider your funding requirements, and, if needed, provide a grace period and resources for the employee to obtain their certification (this indicates an investment in the employee and may increase retention). Certification and training vary throughout the US, and there are no standardized CHW certifications or trainings. Throughout the US, 30 states offer some type of standardized training and, as of January 2024, 25 states have a CHW Certification Program. The Center for Community Health Alignment provided current examples of career progression and CHW certification and training in the state of South Carolina:

Developing career ladders and promoting opportunities for career advancement is one of the ways that LHDs can support CHWs. LHDs can visit the National Academy for State Health Policy’s State Community Health Worker Policy tracker to learn about certification and training, Medicaid reimbursement, and CHW associations and organizations in their respective states.

Another way that LHDs can support CHWs is to partner with CHW associations. The toolkit provides information from Angela Fields, Associate Executive Director of the Minnesota Community Health Worker Alliance (MNCHWA), on how CHW associations can support CHWs.

Sarah Johnson Malchow, a CHW certificate student, also provided insight into her experience working with MNCHWA:

These examples demonstrate how CHW associations help raise awareness of the CHW role and profession in various settings, such as healthcare, public health, communities, and schools. Additionally, CHW associations support CHWs by creating CHW training programs and/or gathering and analyzing statewide data concerning the CHW workforce, interventions, prevalent indicators, and outcomes. Associations also aid in professional development by organizing CHW-focused conferences, webinars, and educational events. To learn more about how CHW associations can support CHWs in LHDs, please see page 27 of the Community Health Worker Toolkit: Capacity Building in Local Health Departments.

Summary

CHWs are essential to many public health organizations, serving as vital connections between LHDs and communities. The Community Health Worker Toolkit: Capacity Building in Local Health Departments provides LHDs with field-tested and evidence-based practices to improve CHW recruitment, hiring, and retention. When developing recruitment strategies, LHDs should focus on crafting job descriptions deliberately, integrating equity practices in the hiring process and marketing to specific population channels. To bolster retention, LHDs should ensure that CHWs are supported in their roles and are provided with opportunities for developing their skills and career advancement. By incorporating inclusive practices into hiring and retention processes, LHDs can cultivate a diverse CHW workforce capable of effectively meeting both community and organizational needs. The NACCHO website and the CPHS website have a webinar where we showcase our toolkit.

Read Our Toolkit and Environmental Scan Report and Watch the Toolkit Webinar on the NACCHO website and the CPHS website.

A special thank you to the following people who we contracted with to contribute content to the creation of this toolkit: Quisha Umemba, Umemba Health, LCC; Bree Allen, Nicollet County Health and Human Services; Angela Fields, Minnesota Community Health Worker Alliance; Julie Smithwick, Center for Community Health Alliance; Amalia Roberts, Dakota County Public Health.

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Dr. Skky Martin is a researcher at the Center for Public Health Systems. Her research interests include health equity, health disparities, social determinants of health, and the interrelationship between public health and medical education. She has experience in qualitative methods and analysis, writing surveys, and using STATA to create and analyze quantitative datasets. Dr. Martin holds a doctoral degree and master’s degree in sociology and a Certificate in Public Health from Loyola University Chicago.

Chelsey Kirkland, PhD, MPH, CHW (she/her) is a researcher within the Center for Public Health Systems at University of Minnesota, School of Public. During her time there, she has collaborated on numerous nation-wide, mixed-methods research projects working to support and build-up the public health workforce. Her background is in a variety of public health issues including health equity, health disparities, social determinants of health, community health workers, and physical activity. When not working, she enjoys being outside with her family and two dogs. Her favorite activities include running, water-skiing, and playing violin.