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Impact of Community Health Worker Certification on Workforce and Service Delivery for Asthma and Other Selected Chronic Diseases

Technical Brief Draft

Open for comment through Oct 22, 2019

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Purpose of Technical Brief

To explore and describe the state of the evidence on community health worker certification and its relationship with community health worker outcomes (such as recruitment, retention, and employment stability) and outcomes for people with asthma and other selected chronic illnesses.

Key Messages

  • A number of states are initiating efforts to certify community health workers practicing in their states.
  • We did not find any studies evaluating the effect of community health worker certification on asthma, diabetes, cardiovascular disease, and maternal-child health outcomes.
  • There are differing opinions about the usefulness and impact of community health worker certification.
  • Additional research is needed to determine effect of certification on community health worker service delivery and workforce development and to identify best practices for instituting certification programs.

Structured Abstract

Background. CHW certification has been proposed to promote the diffusion of the CHW model in healthcare organizations. However, the extent to which health outcomes vary as a function of CHW certification is unclear. There is also a need to clarify the landscape of CHW certification efforts in the United States.

Objectives. The objectives were to (1) determine the effects of certification on CHW recruitment, retention, scope of practice, reimbursement or employer liability; (2) ascertain the effects of certification on quality or consistency of care, health outcomes, or patient/family acceptance, trust, and use of community health workers; (3) elucidate the context of certification requirements and implementation in the United States; (4) identify potential positive and negative implications of requiring certification; and (5) identify future research needs.

Methods. We searched PubMed and CINAHL through April 2019 and handsearched relevant reviews. Our grey literature search focused on reports and presentations by national organizations, foundations, and institutes. We also reviewed the Web sites of state health departments which have CHW certification programs. We conducted interviews with Key Informants representing stakeholders in the CHW certification enterprise. We used these interviews to identify themes to contextualize findings from the published and grey literature searches.

Results. The evidence base for community health worker certification is sparse. Our published literature search identified a handful of studies examining correlates of certification (i.e., training, recruitment, and scope of practice) with health outcomes, but these were not linked to the broader issue of certification (n=4, 0 about asthma). We did not find any studies that evaluated the relationship between CHW certification and CHW retention, reimbursement, employer liability, or patients' and families’ trust in and receptivity to CHWs. We did not find any studies suggesting that patients' outcomes differ as a function of intervention from a certified versus non-certified CHW, or that certification influences the quality or consistency of CHW-delivered interventions. We identified 37 documents through our grey literature search. Interviews with Key Informants identified four overarching themes: (1) the perceived utility of certification, (2) the philosophical/ethical considerations influencing certification, (3) its potential effects, and (4) recommended components and approaches. The majority of participants asserted that certification does not affect health outcomes. There were diverging opinions about the perceived and actual impact of certification on the CHW workforce, including recruitment, retention, career advancement, composition, and the financial viability of the CHW model.

Conclusions. In the absence of evaluations of the relationship between certification and outcomes related to patients' and families' health, and dimensions of CHWs' workforce development, the impact of CHW certification is more speculative than conclusive. Further research is needed to determine if certification is linked to improved outcomes for people with asthma and other chronic illness outcomes.