Making the system work for everyone
The Business Case for CHWs
Career advancement for Community Health Workers (CHW) is important to consider when expanding an organization’s workforce to include CHWs. As the CHW workforce grows and becomes more accepted within Connecticut’s State Innovation Model Community and Clinical Integration Program (CCIP) within the Advanced Networks and the Patient Centered Medical Home Plus program, job security and advancement must be incorporated into the organization’s plans.
As an employer begins to incorporate CHWs into its practice, it is important to plan ahead for how CHWs can advance their careers and move up in the organization as they master their position and seek to expand the horizon of their work. As CHWs acclimate to their positions and become valuable members of their teams, their contributions to the organization should be recognized. Advancement and recognition can be accomplished by providing opportunities for CHWs to grow through specialization, continuing education, or expansion of duties, which duties may include supervisory or training roles for other CHWs. Such career ladders are widely regarded as effective means of fostering the growth of CHWs within the agency or organization.
In their CHW E-Learning Series, the Center for Disease Control describes three specific needs to be met in order to improve career development for the CHW workforce:
- CHWs need a career ladder with advancement options.
- CHWs need pathways to related careers and special supports in pursuing these pathways.
- CHW employment should be viewed as a possible entry to the workforce for welfare recipients and for people who were formerly incarcerated.
It is recommended that CHW employers keep these needs front and center as they build their teams.
The Centers for Disease Control describes how employers can create career ladders for CHWs: “As with many entry-level jobs, employers may offer salary increases and upgraded job titles for increasing levels of independent responsibility, including graduated levels of supervisory responsibility.” As CHWs gain experience and participate in continuing educational opportunities, they often serve as mentors to new CHWs and other staff, and may eventually serve as trainers. This is often a result of the central quality of the CHW’s role: not only to provide for and serve their clients, but also to enhance the capabilities of their peers. Per the CDC:
“Experienced CHWs can make excellent trainers, and this responsibility can offer job enrichment as well as opportunities for higher pay. Another option is to create specialist CHW positions, such as breast-feeding counselor within a WIC program, or medical interpreter. Certification for specialized duties can carry an enhanced job title and supplemental pay. Finally, larger employer organizations may wish to create senior CHW positions as troubleshooters or consultants, who assist other CHWs or teams with problem solving or setting up special projects.” 
Example of possible levels for a CHW Career Ladder:
- CHW 1: Health Education, Basic Health Assessment, Visual screening for red flags.
- A specialty topic could dictate a particular ladder; there could be separate ladders for, e.g., Women’s Health, Diabetes, Asthma, Breastfeeding, Children’s Health, Behavioral Health, Dental, HIV, etc.
- CHW 2: Eligibility Screening, Health Insurance Enrollment, Prevention Screening, Lifestyle Change Counseling (e.g., exercise classes, diet advice, etc.)
- CHW 3: Patient Engagement with PCP for Preventive/Routine Care, Medical Interpreting, Training and Job Shadowing Mentor for new CHWs
- CHW Lead: Supervising CHWs, Leading Team Meetings, Participating in Grand Rounds
Certification can be required of all CHW levels of the career ladder, or may begin with CHW II or III. The Lead CHW should be certified.
It should be recognized that a CHW may choose to have community health work as a lifelong career, or they may choose a CHW position as a “[stepping stone] to other health-related occupations”; such CHWs are referred to as “up and out” CHWs. Employers may provide such up and out CHWs with exposure and access to “established health career tracks in areas such as patient care, clinical technician, or medical administration.” 
 Scott, Geri and Wilson, Randall. “Community Health Worker Advancement: A Research Summary”, Jobs for the Future April 2006, Report funded by the Robert Wood Johnson Foundation. http://www.jff.org/publications/community-health-worker-advancement-research-summary works.org/Downloads/chwressumm.pdf