California Association of Community Health Workers

Incorporated as a 501c3 

Articles of Incorporation: 02/04/2022 ( CACHW birthday! )  

Filing Number 4845442

 EIN:  92-0739649  

Vision Statement: 

A multiculturally inclusive Community Health Worker (CHW) learning collaborative that advances the CHW role and scope of practice and amplifies their voices in achieving health equity and social justice within the full spectrum of practice settings in California.   

Mission statement: 

To  promote  sustainable integration and professional recognition of the Community Health Worker workforce through partnerships, leadership development, education, training, capacity building, community organizing, and policy advocacy. 

Bylaws

In keeping with National Association of CHW (NACHW) recommendations, the CACHW board will always be at least 50+1% CHWs ( "Nothing about us without us") 

Founding Board 2022

• Monique Allen CHW
• Felipe Flores CHW
• Lucia Gonzales Cloud CHW
• Silvia Ortega CHW
• Darouny Somsanith CHW
• Carol West CHW

Current Board 2024

Collective impact is a network of community members, organizations, and institutions that advance equity by learning together, aligning, and integrating their actions to achieve population and systems-level change. (Collective Impact Forum)

Equity is fairness and justice achieved through systematically assessing disparities in

 opportunities, outcomes, and representation and redressing disparities through targeted actions  (Urban Strategies Council)

ACKNOWLEDGEMENTS

We would like to thank our community partners at the California Association of

Community Health Workers, including Carol West and Darouny Somsanith; the

community health workers who served as key research partners, including Monique Allen,

Barbara Lugo, Angelica Nevarez, Bill Sive, and Estela Venegas-Martinez, all of whom are

contributors to this work and served as authors on the manuscript that is currently under

review; and Felicia Silvas, who served as an excellent focus group facilitator. We are also

grateful to Health Leads for their financial support and to Health Outreach Partners for

their guidance in early project planning. Without the efforts and commitment of everyone,

this project would not be possible.

Sincerely,

Caroline Murtagh, BS

Michelle Gimenez, MA

Elizabeth Rouffy, BS

Jennifer Newberry, MD, JD, MSc

CHW Research Team  Newberry Lab,

Stanford University School of Medicine

SUMMARY

The following summary outlines the context, methods, and findings from a series of focus

groups with Community health workers (CHWs) throughout California. This project aimed

to provide a preliminary exploration of CHW perspectives of their own personal and

professional identities as well as the future of the workforce in the state. The number of

participants that could be recruited was limited by total funding, and therefore, we regard

our findings as hypothesis-generating. Detailed findings are forthcoming and are currently

under review as a manuscript.

BACKGROUND & OBJECTIVES

Community health workers (CHWs) are uniquely positioned to enhance healthcare access

in medically underserved communities given their high levels of trust, experience

navigating social support systems, and implementation experience of community-based

models of care delivery. In California, increased recognition of CHWs and uptake in clinical

settings and social organizations has led to policies that aim to advance the

professionalization of this role, including new reimbursement mechanisms and

development of future certification requirements. However, little research exists on

perceptions of CHWs themselves on professionalization policies. Thus, using a

participatory action research approach, where CHWs were included as key members of

the research team, this project sought to explore the perspectives of CHWs in California

toward their personal and professional identities, the potential impact of increased

professionalization policies, and their future visions for workforce collective organizing to

drive changes to the profession.

METHODS

Using a participatory action research approach, our team of CHWs from throughout

California and academic researchers from Stanford University conducted a qualitative

study with focus groups of CHWs in five regions and one group representing CHWs in Tribal

communities, with overall representation from across the state. In the first stage of the

project, the research team selected and trained six CHW facilitators to co-lead focus

groups in their respective geographic regions (e.g. Northern, Central, and Southern

California and one Tribal group). CHW facilitators participated in study design and focus

group guide development. The Stanford research team recruited participants using a

purposeful sampling strategy to ensure a diverse representation of CHWs across gender,

race, ethnicity, type of organization, and population served. Focus groups were held from

November 2022 - March 2023 using a semi-structured focus group guide that explored

concepts including identity, assets, challenges, workforce priorities, and sources of

representation and belonging. The focus groups took place in English and Spanish. After

each focus group, debriefs were held amongst the researcher and CHWs facilitators, and

field notes were compiled for each session. All interviews were transcribed, translated

from Spanish to English, and analyzed using both deductive and inductive coding

approaches. The entire team, including both the CHW facilitators and Stanford

researchers, conducted thematic analysis through in-depth discussion of codes and

quotes.

RESULTS & DISCUSSION

Demographics

28 participants from 27 different organizations participated in six focus groups. While

participants were primarily female, they were diverse in race, ethnicity, and type of

organization they were affiliated with/worked for.

Key Finding 1: Shared “Lived Experience” with community members is an

important employable asset and source of expertise of CHWs, but it

comes with financial and social costs that should be recognized and

compensated.

“Lived experience,” a term taken directly from focus group discussions, refers to the

personal experiences endured and knowledge gained by participants in contrast to

information acquired through formal education systems. Participants identified language

and culture, socioeconomic status, and personal hardships (e.g. incarceration,

immigration, homelessness, sickness) as elements of lived experience, and emphasized

how lived experience enables them to connect with and serve communities through

increased knowledge of resource systems and community networks. However, they also

noted heavy social, economic, and political costs that come from these experiences that

they share with their communities, such as continued housing instability, financial

vulnerability, and language barriers. Furthermore, participants highlighted the importance

of not only recognizing lived experience as a valid credential in certification processes, but

also appropriately compensating CHWs for this knowledge, similar to how degrees are

valued. Healthcare systems and social organizations employing CHWs should consider

material and social investments to address the underlying structural conditions that

contribute to these lived experiences. For instance, supervisors could advocate for

allocation of time and resources as social support to CHWs themselves, given the

disproportionate structural vulnerability they often face in comparison to non-CHW

colleagues.

Key Finding 2: While professionalization may advance rigor and

standardization of training as well as recognition and compensation for

some CHWs, it also threatens to exclude those who are unable to adhere

to traditional routes of career development.

We identified a central tension that has developed within CHW workforces in the context of

professionalization policy discussions: while standardization of training, development of

certification programs, and stable reimbursement mechanisms through Medicaid offer

potential avenues for enhancing CHW skill-building, recognition, and compensation, some

members of the workforce may be excluded by the same increased levels of specialization

and job eligibility requirements. For instance, while the California Department of Health

Care Access and Information (HCAI) recommends CHWs could attest to lived experience

as a qualification for certification in preliminary certification discussions, participants in

focus group discussions feared that employers benefitting from new funding mechanisms,

such as clinics utilizing Medicaid reimbursement, may still implement employment

requirements that are inaccessible for certain CHWs. This may take the form of requiring

additional degrees, English language proficiency, or citizenship documentation, which may

lead the most vulnerable but skilled CHWs to be crowded out by those with formal

education but without exposure to experiences that meaningfully inform practice.

Furthermore, participants feared that standards of professionalism in the workforce may

disadvantage those who come from marginalized communities, such as those

transitioning from incarceration or homelessness to serve in the CHW role. Thus, our

research calls for professionalization efforts to be complemented by continued discussion

on standards of professionalism which incorporate CHW voice and insights.

Key Finding 3: Shared interests among CHWs may serve to initiate

collective organizing across the state, but further research is necessary

to explore strategies for bringing people together with diverse languages,

experiences, and cultures.

The CHWs participants in this study identified many common areas for improvement in

their workforce, such as fair compensation, increased benefits, upward mobility, and

further inclusion of diverse CHWs in the context of ongoing professionalization, that could

be used to unify members of the workforce across the state to drive the future of the

profession. However, this research, even with its smaller sample size, also elicited the

huge diversity of CHWs across race, ethnicity, language, and workplace setting, which may

complicate efforts to collectively organize. One option suggested by participants was the

formation of regional networks, which may be better suited to honor regional interests and

cultural differences. Other participants noted the importance of a statewide organization

to support collective CHW interests. Overall, there was interest amongst many

participants in spaces to come together with fellow CHWs to receive and give peer-to-peer

support.

Introduction

Founding members have been meeting regularly since January 2021. At our first all member retreat on June 7, 2021 we crafted our personal vision and mission statements which were subsequently crafted by a smaller workgroup into proposed collective vision and mission statements. The group agreed that we would use the APHA /NACHW CHW definition as an umbrella for the many CHW job titles and that CHW and Allies would self identify.

Based in the following values /principles 

• Promote CHW leadership and self determination
• Be inclusive of multicultural diversity 
• Honor mutual respect
• Advocate with compassion and commitment
• Inspire collaborative learning with the freedom to explore innovative ideas

Several group agreements informed this process:

Prior to developing the Vision and Mission statements, the CA CHW organizing group agreed to the following: 

1. The organization will be a Community of Practice who share a common concern, and interest in a set of problems, or an interest in a topic and who come together to fulfill both individual and group goals. (See Creating Communities of Practice.)   In this case support of the Community Health Worker workforce, actively recruiting CHW as well as allies.  
2. The organization will use the American Public Health Association (APHA)/National Association of Community Health Workers (NACHW) definition of CHW as an umbrella term for all job titles:
3. Anyone who self-identifies as a CHW based on the APHA/NACHW definition will be considered a CHW by the CA CHW CoP; all other members will be considered allies. 
4. Our primary goal is to advocate for and support the emergence of a multicultural state level Community Health Worker association in California.

NACHW Definition of CHW 

"A Community Health Worker (CHW) is a frontline public health worker who is a trusted member of and/or has an unusually close understanding of the community served. This trusting relationship enables the CHW to serve as a liaison/link/intermediary between health/social services and the community to facilitate access to services and improve the quality and cultural competence of service delivery. A CHW also builds individual and community capacity by increasing health knowledge and self-sufficiency through a range of activities such as outreach, community education, informal counseling, social support and advocacy."

The vision and mission statements were crafted from an integration of the individual vision and mission statements from June 7, 2021 retreat.  

 Vision Statement: 

A multiculturally inclusive Community Health Worker (CHW) learning collaborative that advances the CHW role and scope of practice and amplifies their voices in achieving health equity and social justice within the full spectrum of practice settings in California.   

Mission statement: 

To  promote  sustainable integration and professional recognition of the Community Health Worker workforce through partnerships, leadership development, education, training, capacity building, community organizing, and policy advocacy. 

Next steps will be to take this proposed vision and mission out to the wider CHW and ally community for discussion and feedback via a survey and small discussion groups/forums online and in person (covid restrictions permitting.)The   Vision and Mission Survey  was a "snowball" distribution through our newsletter CHW~LINK and distribution lists of our members. 

A collaborative organizational development committee formed from founding members and those who come forward to do the work of organizational development. We have been meeting on the first and third Mondays from 12 -1pm.  

Several areas of interest were identified by participants and two coordinators volunteered to facilitate each special interest group.

Special Interest Groups (SPIG) 

• CHW Organizational Development 
• CHW Professional Development 
• CHW Workforce , Training and Employment 
• CHW Policy  ( and Advocacy)
• CHW Research and Evaluation and Journal Club 
• CHW Sustainable Financing

California Association of Community Health Workers (CACHW)

Out of the Professional Development Group a core group of CHWs took the first steps to establishing a California Association of Community Health Workers. (CACHW). We have submitted and been approved as a legal entity. In other words  we have an organizational "birth certificate" or a "building permit" . The intention is to build from the ground up with CHWs in the drivers seat and allies as trusted navigators/advisors.  It will take everyone working together to make this dream a reality.

The CACHW team's next step is to do a "CA CHW Listening Tour" to ask multicultural CHW from across California what their priorities are in building  a California Association of Community Health Workers. 

Strategic plan for  June 2022- June 2023 

It is over a year since our last retreat/strategic planning session and time to think about next steps for the coming year.   To this aim we have engaged a professional facilitator to guide us through a strategic planning process to help us map out next steps:   

• Clarify goals and set priorities 
• Establish key performance indicators ( Metrics)  
• Develop a project plan with action steps and workflow accountability 

Upcoming opportunities to participate will be share through the CHW~LINK newsletter which you can sign up for by completing this interest form 

   Rank  Language                 Est. Number of Speakers

1. English                         20,379,282
2. Spanish                       10,672,610
3. Chinese                       1,231,425
4. Tagalog                        796,451
5. Vietnamese                 558,932
6. Korean                         367,523
7. Armenian                    192,980
8. Persian                         203,770 

Tuesday, October 30, 2012 : 10:50 AM - 11:10 AM

Carol West, CHW; BSC OT; MBBCH; DCH , Community Health Worker Initiative of Sonoma County (CHWISC), Petaluma, CA Stephanie Merrida-Grant, CHW , Community Health Worker Initiative of Sonoma County (CHWISC.org), Petaluma, CA Cynthia Morfin, CHW , Community Health Worker Initiative of Sonoma County (CHWISC.org), Petaluma, CA 

"Think globally but act locally" is the mobilizing premise of the Community Health Workers (CHW) who in January 2011 founded the Community Health Worker Initiative of Sonoma County in California. Using core CHW competency skills we are building relationships in our community with frontline health workers, with many different job titles and diverse cultural back grounds, whose scope of practice falls within the APHA definition of a CHW. Attending regional and national conferences that support the professional development of CHWs, facilitated our learning about health policy advances made in other states, peer support models that are successfully supporting the professional role and scope of practice of the of the CHW throughout the USA. Learning from the national leaders in our field has expedited the process of organizational development of our own peer support network , building local leadership capacity, promoting cultural humility and inclusivity, advocating for lifelong learning, ongoing professional development and self advocacy. Our work is extremely challenging. If we are to be effective builders of healthy communities and advocates for our families, friends and neighbors, we must first build our own professional community at a local, regional state and national level to keep our hope and tenacity alive to motivate the work that still must be done to build a more equitable and just health care system in our country. While we are excited about the possibilities that the affordable health care act might bring; we share what can be done with passion, vision and commitment. 

Community Health Worker Initiative of Sonoma County

The National Association of Community Health Workers (NACHW) and many CHW advocacy collaboratives, alliances and associations across the USA are using the APHA- Community Health Worker Section (APHA)definition

"A Community Health Worker (CHW) is a frontline public health worker who is a trusted member of and/or has an unusually close understanding of the community served. This trusting relationship enables the CHW to serve as a liaison/link/intermediary between health/social services and the community to facilitate access to services and improve the quality and cultural competence of service delivery. A CHW also builds individual and community capacity by increasing health knowledge and self-sufficiency through a range of activities such as outreach, community education, informal counseling, social support and advocacy."

NACHW National Survey of CHW Membership organizations June 2018 https://nachw.org/wp-content/uploads/2019/12/Report-Results-of-a-national-survey-of-CHW-membership-organizations-for-Dissemination.pdf

Bureau of Labor and Statistics (BLS)Standard Occupational Classification (SOC)

21-1094 

Community Health Workers Assist individuals and communities to adopt healthy behaviors. Conduct outreach for medical personnel or health organizations to implement programs in the community that promote, maintain, and improve individual and community health. May provide information on available resources, provide social support and informal counseling, advocate for individuals and community health needs, and provide services such as first aid and blood pressure screening. May collect data to help identify community health needs. Excludes “Health Educators” (21-1091).

Illustrative examples: Peer Health Promoter, Lay Health Advocate

Broad Occupation: 21-1090 Miscellaneous Community and Social Service Specialists
Minor Group: 21-1000 Counselors, Social Workers, and Other Community and Social Service Specialists
Major Group: 21-0000 Community and Social Service Occupations 

Peer Support Specialist  The U.S. Bureau of Labor Statistics does not collect data specifically on peer support specialists. Instead, it counts them among community health workers, of which 51,900 were employed in May 2016. 

BLS Occupational Outlook Handbook https://www.bls.gov/ooh/community-and-social-service/health-educators.htm

 Community- Based Workforce Alliance; 

Partners: Health Begins; Health Leads; NACHW

Principle 1: Recruit & manage with a racial equity framework

Principle 2: Invest in trusted voices, including Community Health Workers

Principle 3: ​Strengthen connections with psychosocial services & systems

Principle 4: ​Launch a community-based jobs program as a force multiplier

Principle 5: Embed job training & pipelines to local careers

Principle 6: ​Strengthen community infrastructure & financing

Tuesday, October 30, 2012 : 10:50 AM - 11:10 AM

Carol West, CHW; BSC OT; MBBCH; DCH , Community Health Worker Initiative of Sonoma County (CHWISC), Petaluma, CAStephanie Merrida-Grant, CHW , Community Health Worker Initiative of Sonoma County (CHWISC.org), Petaluma, CACynthia Morfin, CHW , Community Health Worker Initiative of Sonoma County (CHWISC.org), Petaluma, CA 

"Think globally but act locally" is the mobilizing premise of the Community Health Workers (CHW) who in January 2011 founded the Community Health Worker Initiative of Sonoma County in California. Using core CHW competency skills we are building relationships in our community with frontline health workers, with many different job titles and diverse cultural back grounds, whose scope of practice falls within the APHA definition of a CHW. Attending regional and national conferences that support the professional development of CHWs, facilitated our learning about health policy advances made in other states, peer support models that are successfully supporting the professional role and scope of practice of the of the CHW throughout the USA. Learning from the national leaders in our field has expedited the process of organizational development of our own peer support network , building local leadership capacity, promoting cultural humility and inclusivity, advocating for lifelong learning, ongoing professional development and self advocacy. Our work is extremely challenging. If we are to be effective builders of healthy communities and advocates for our families, friends and neighbors, we must first build our own professional community at a local, regional state and national level to keep our hope and tenacity alive to motivate the work that still must be done to build a more equitable and just health care system in our country. While we are excited about the possibilities that the affordable health care act might bring; we share what can be done with passion, vision and commitment. 

Community Health Worker Initiative of Sonoma County

Alameda County Health Care Services Agency

Program Name: Alameda County Health Coach Program

Program Overview: Alameda County is expanding and strengthening the Alameda County Health Coach Program (HCP), a state-approved apprenticeship program that trains, educates, employs, and mentors young adults, immigrants, and other residents as CHWs. HCP trains and employs CHWs from ethnically diverse and historically underserved communities to connect African American, Latino, Pacific Islander, and Mam-speaking residents from five neighborhoods within the county to COVID-19 response services.

Total Funding Amount: $2,196,600

Point of Contact: Emily K. Kaplan

County of San Diego Health and Human Services Agency

Program Name: County of San Diego-Community Health Worker (COSD-CHW) Program

Program Overview: The COSD-CHW Program aims to elevate the work of CHWs across San Diego County by expanding an existing collaborative into a CHW Community Coalition. The coalition is planning activities to engage CHWs, implementing a regional CHW training program, and deploying new, full-time CHW Liaisons who coordinate outreach, education, and communication among CHWs.

Total Funding Amount: $3,000,000

Point of Contact: Rosa Garcian

San Joaquin County Human Services Agency

Program Overview: The San Joaquin County Human Services Agency is embedding CHWs into 14 neighborhoods that are at increased risk for COVID-19. CHWs are conducting community outreach and partnership development activities, including health education, screenings, and referrals to medical care and services, to increase access to services and overcome barriers to care. The program builds on an existing CHW sustainability initiative, which investigates Medicaid reimbursement options for CHW-provided services.

Total Funding Amount: $2,983,938

Point of Contact: Monica White

Sonoma County Health Services Department

Program Overview: The Sonoma County Health Services Department is developing a standardized CHW training curriculum and building a community consortium of community clinics, hospital systems, community-based organizations, family resource centers, and health departments to guide, coordinate, and sustain the integration of CHWs into organizations and care teams. These efforts aim to increase vaccination rates among Sonoma County residents and improve uptake of health care services in communities with low health performance indicators.

Total Funding Amount: $6,000,000

Point of Contact: Martin Rivarola

Tulare County Health & Human Services Agency

Program Name: Tulare County Public Health CHW Training Program

Program Overview: The Tulare County Health and Human Services Agency is working with partners to incorporate CHWs and other community partners into mass outreach efforts. Through an existing community coalition, CHWs will provide community education to people at high risk for COVID-19 exposure, infection, and illness, including those in rural communities and/or working in the farming or agricultural industry.

Total Funding Amount: $1,800,000

Point of Contact: Tiffany Swarthout

Tule River Indian Health Center Inc.

Program Name: Insaxo – Tribal Community Health Worker Project

Program Overview: Tule River Indian Health Center is working with a wide range of partners to establish a regional coalition and develop indigenous community health outreach teams to provide COVID-19 services, home-based health monitoring, and referral services. Outreach teams consist of CHWs, nurses, peer mentors, and indigenous volunteers and serve American Indian and/or Alaska Native residents of Tulare County.

Total Funding Amount: $1,050,000

Point of Contact: Eric Coles

United American Indian Involvement (UAII)

Program Name: Education and Implementation of Community Health Workers to Serve the American Indian Community in Southern California

Program Overview: Working in American Indian and Alaska Native communities across Los Angeles and Orange counties, UAII and its partners are hiring and training a new cohort of CHWs who will be integrated into UAII's LA American Indian Health Project clinical care teams.

Total Funding Amount: $3,250,000

Point of Contact: Rene Short