Foundations for Community Health Workers
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Foundations for Community Health Workers

Timothy Berthold, Timothy Berthold

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eBook - ePub

Foundations for Community Health Workers

Timothy Berthold, Timothy Berthold

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About This Book

Training, credentialing and employment opportunities for Community Health Workers (CHW) are expanding across the nation. Foundations for Community Health Workers, 2nd Edition provides a practical and comprehensive introduction to essential skills for CHWs, with an emphasis on social justice, cultural humility, and client-centered practice. Real-life case studies and quotes from working CHWs illustrate challenges and successes on the job. For additional details, please visit:

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Photo of 2 men walking under a Coca-Cola advertising board under which are texts PRODUCE, LIQUORS, and GROCERIES.

Chapter 1
The Role of Community Health Workers

Darouny Somsanith and Janey Skinner
Photo of CHWs smiling for the camera. The 7 CHWs at the front are sitting; the rest at their back are standing.
I was homeless, living in a shelter with my daughter. There was a nurse practitioner who provided prenatal care at the shelter two days a week. When a pregnant woman came in, sometimes they came in the middle of the night, so I would give them a short presentation about the prenatal services at the shelter, and tell them when the nurse practitioner lady was coming in.
I didn't know why I was doing it, I just was doing it. I got housing after three months of being at the shelter. While I was there, I was interacting with the nurse practitioner. And when I got ready to move into my housing, she asked me did I want to become a community health worker for her. I'm like, “Sure, but what is a community health worker?” I was the second CHW with her organization. She had just started this organization called the Homeless Prenatal Program, and she and a part-time social worker took me on the streets to show me what a CHW does. I learned the ropes and I used my life experience, and the part-time social worker showed me what to do in the community, and then I just took off from there. That's how I became a CHW.
—Ramona Benson, Community Health Worker Black Infant Health Program, Berkeley, California


This chapter introduces you to the key roles and competencies of community health workers (CHWs) and addresses common qualities and values of successful CHWs. It will also introduce you to the four CHWs pictured in the photograph that appears on page 22 in this chapter. They are each graduates of the CHW Certificate Program at City College of San Francisco, on which this book is based. Their quotes and photographs appear throughout the book, providing examples of the work they do to promote community health.
You may already possess some of the qualities, knowledge, and skills common among CHWs.
  • Are you a trusted member of your community?
  • Have you ever assisted a family member or friend to obtain health care services?
  • Are there things harming your community's health that you feel passionate about changing?
  • Have you participated in efforts to advocate for social change?
  • Do you hope that, in your work, you can work with your community members to become healthy, strong, and in charge of their lives?
If you answered yes to any of these questions, you have some of the characteristics of a successful CHW.


By studying the information in this chapter, you will be able to:
  • Describe CHWs and what they do
  • Identify where CHWs work, the populations they work with, and the health issues they address
  • Explain the core roles that CHWs play in the health and social services fields
  • Discuss the core competencies that CHWs use to assist individuals and communities
  • Describe personal qualities and attributes that are common among successful CHWs
  • Discuss emerging models of care and opportunities for CHWs


  1. Advocate (noun and verb)
  2. Capitation
  3. Credentialing
  4. Health Inequalities
  5. Social Justice

1.1 Who Are CHWs and What Do They Do?

CHWs help individuals, families, and communities to enhance their health, access services, and to improve the conditions for health, especially in low-income communities. CHWs generally come from the communities they serve and are uniquely prepared to provide culturally and linguistically appropriate services (HRSA, 2007; Rosenthal, Wiggins, Brownstein, Rael, & Johnson, 1998; Rosenthal et al., 2010). They work with diverse and often disadvantaged communities at high risk of illness, disability, and death.
CHWs provide a wide range of services, including outreach, home visits, health education, and client-centered counseling and care management. They support clients in accessing high-quality health and social services programs. They facilitate support groups and workshops and support communities to organize and advocate (to actively speak up and support a client, community, or policy change) for social change to advance the community's health and welfare. CHWs also work with health care and social services agencies to enhance their capacity to provide culturally sensitive services that truly respect the diverse identities, strengths, and needs of the clients and communities they serve.
As a result of the work of CHWs, clients and communities learn new information and skills, increase their confidence, and enhance their ability to successfully advocate for themselves. Most important, the work that CHWs do reduces persistent health inequalities or differences in the rates of illness, disability, and death (or mortality) among different communities, in particular those differences that are preventable, unfair, and unjust (Hurtado et al., 2014).
The American Public Health Association adopted an official definition for CHWs during their annual meeting in 2009, a definition developed by CHWs along with researchers and advocates:
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. (APHA, 2009)
The Bureau of Labor Statistics adapted this definition to establish a standard occupational classification (SOC) for CHWs in 2010, for the first time distinguishing CHWs as a profession in standard employment statistics. Prior to this, CHWs were included in the broad category of “social and human service assistants.”
The U.S. Bureau of Labor Statistics forecasts a 25 percent growth rate for CHWs over the 10-year period 2012–2022, so while official recognition of the CHW profession is recent, interest in employing CHWs is widespread. This growth rate is faster than average, when compared to other occupations (BLS, 2014). Health departments, community-based organizations, hospitals and clinics, foundations, and researchers value the important contributions of CHWs to promoting the health and well-being of low-income and at-risk communities.
You might know a CHW already. You might be one. CHWs work under a wide range of professional titles. Some of the most popular are listed in Table 1.1.
Table 1.1 Common Titles for CHWs
Case manager/Case worker
Community health advocate
Community health outreach worker
Community health worker
Community outreach worker
Community liaison
Community organizer
Enrollment specialist
Health ambassador
Health educator
Health worker
Lay health advisor
Public health aide
Patient navigator
Peer counselor
Peer educator
Please watch this video interview
about becoming a CHW. The interview features two CH...

Table of contents

Citation styles for Foundations for Community Health Workers
APA 6 Citation
[author missing]. (2016). Foundations for Community Health Workers (2nd ed.). Wiley. Retrieved from (Original work published 2016)
Chicago Citation
[author missing]. (2016) 2016. Foundations for Community Health Workers. 2nd ed. Wiley.
Harvard Citation
[author missing] (2016) Foundations for Community Health Workers. 2nd edn. Wiley. Available at: (Accessed: 14 October 2022).
MLA 7 Citation
[author missing]. Foundations for Community Health Workers. 2nd ed. Wiley, 2016. Web. 14 Oct. 2022.